Debates of May 3rd, 2016

Criminal Code

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, I am pleased to rise to speak to Bill C-14, the government's response to the Carter decision that we have recently dealt with by tabling this particular piece of legislation.

I wish to state at the outset that I will be supporting the bill, but with some reservations. I will explain why I believe the bill deserves support, but by the same token, I believe that somehow in a future Parliament the bill could go further.

I intend to engage in this discussion by going through three thematic components in the brief 10 minutes I have to make my contribution to this important debate. I know this has been at times an emotional issue for parliamentarians, but in the three thematic components, I wish to give my rationale for my support at this time.

The first of the three themes looks at the moral considerations that many members and much of the broader public have expressed. Second, I want to discuss perhaps more fulsomely our duty as parliamentarians to respond to issues of constitutionality, particularly when they are challenged in the courts. Third, in the short remaining time I will have, I wish to express some personal thoughts on this as it impacts me directly.

First, I want to thank many constituents in my riding of Scarborough—Agincourt for their interventions on this subject. This has been an emotional matter, and I would have to state on the record that the overwhelming majority of constituents who reached out to me are opposed to the government introducing Bill C-14. That has been primarily on moral grounds. They feel that allowing physician-assisted death is essentially tantamount to murder.

In the opportunities I have had to discuss this matter with my constituents, I made it clear that Parliament is under a positive obligation to respond to the decision in the Carter case. If Parliament does not present some form of legislation, the consequence of its failure to do so would mean that the provisions of section 14 and subsection 241(b) of the Criminal Code would no longer be operative as of June 6. We would essentially be left in the situation of a legislative vacuum. It is important to put a regulatory framework around physician-assisted death.

As I pivot from the issue of morality to the issue of our responsibility as parliamentarians, I want to raise the point that while morality is important, and this has been a theme discussed in the House, ultimately we as parliamentarians must first make sure that we put in laws that pass the constitutional test. Where the Supreme Court of Canada has rendered a decision indicating that something is not constitutional, that it is a breach of some form of the constitution, whether on jurisdictional grounds or on grounds under the charter, Parliament needs to respond. In my view, that is what the government is doing in Bill C-14, under a very difficult timeline. That is perhaps why there has been a decision to introduce Bill C-14 in a relatively controlled and restrictive manner. It is reflective of the fact that we are under a very tight time obligation.

Therefore, I understand why the Minister of Justice, the Minister of Health and others, who have done yeoman's work in this regard, have taken initial steps to make sure it meets the constitutional test set out by the Supreme Court of Canada. However, in my view, it does not necessarily go far enough.

I want to pay tribute to the ministers and to all the other many parties and Canadians who have contributed to the debate. I note that there was incredible work done by the Special Joint Committee on Physician-Assisted Dying, led by Senator Ogilvie and the member for Don Valley West. I want to pay tribute to all the members who participated in that committee.

I want to note the contributions of the federal external panel, the provincial-territorial expert panel, and the many stakeholders and Canadians who have contributed to this very difficult debate.

I would note, though, that not only have many of my constituents expressed concerns with respect to this particular bill, but in some specific instances they have asked us to consider invoking the section 33 notwithstanding clause found in the charter, which of course is the legislative override provision. I would view that as a more sophisticated way of saying they oppose it and that ultimately parliamentarians should please consider overriding the charter rights of certain individuals by invoking or using the notwithstanding clause.

I would say to those individuals who have expressed that particular feeling that this is something we have to do and tread upon very carefully, particularly where we are potentially treading on rights that have been protected under the Canadian Charter of Rights and Freedoms. I would submit respectfully that it is important we do so in a manner that follows the tests that are similarly found in section 1 that were ultimately articulated in the Oakes decision that deals with the judicial override clause that is found in the charter.

Under Oakes, there are essentially three tests that need to be met, and if any one of those tests fails, namely in dealing with the judicial override, then one would not be able to invoke section 1, and I would argue that one would have to use the same principles under section 33 in exercising the legislative override. Those three tests basically deal with rational connection, that the impairment is done in as minimal a way as possible, and that we look at the deleterious effects and salutary benefits of any limitation that is imposed under section 1.

Typically, in application of section 1 of the charter in most instances, the failure falls under the second test, that the impairment is not as minimal as possible. Certainly, that was the basis in which the section 1 test was applied in Carter and which the court found that the proposed absolute ban on physician-assisted death did not meet the minimal impairment test. The court had carefully gone through the trial judge's analysis and concurred with the trial judge's position with respect to the application of section 1.

In terms of whether we would consider invoking section 33, as I mentioned already, this Parliament, this House of Commons, has never exercised section 33 as a legislative override, and I would argue that we too should be extremely careful. That is the test that we need to apply as parliamentarians in terms of determining whether we feel it is appropriate to use the legislative override.

As I mentioned before, the bill seeks to meet in a very expedited fashion a court-imposed time challenge and to deal with the suspension of the declaration of invalidity under sections 14 and 241 of the Criminal Code of Canada. We must do so by June 6.

As I have indicated before, I will be providing my support for the bill, but I would argue that there are a couple of additional things that we as a Parliament need to consider in the future. These were articulated quite clearly in the report from the special joint committee of the Senate and the House of Commons.

My first issue is that the bill currently does not deal with the issue of advance directives. I am sympathetic to those Canadians, particularly those who are suffering from diseases like ALS and others, who may still be in quite good shape at the present time, but at some future point, when they are getting close to their end-of-life situation, will not be able to express their particular consent. In my view, the issue of a clearly articulated regulatory framework that allows for advance consent should be considered.

I am also—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I am sorry, but the time is up. The member will be able to finish through questions and comments.

[Scott Reid, Conservative, Lanark—Frontenac—Kingston, ON]

Madam Speaker, part of what I am doing in raising my intervention at this point is to actually give my colleague the opportunity to finish off the point he was making, which I think was quite close to his conclusion.

As he does, I wonder if he could also address something that came up in his discussion of advance directives, which was the very last thing he was addressing. He mentioned individuals who suffer from ALS. I would submit to him, and I would be interested in his response to this, that the Supreme Court's jurisprudence in this matter is based entirely on cases of individuals with ALS who approach death in a very atypical manner, in that their minds typically are completely intact while their bodies are completely frozen.

Advance directives, I would submit, are primarily something that deals with the opposite situation, where the person's body may be fine, but the mind is gone, most obviously someone who is affected by Alzheimer's or some other form of dementia.

If the member could work that into his comments, I would appreciate it. If not, I would very much like to hear the rest of what he has to say.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Madam Speaker, I thank my colleague for his generosity.

I was simply getting to the issue of mature minors, to say that I do have some additional trouble and am concerned about appropriate safeguards. That was my other particular area of concern.

Let us get back to the question that my friend posed with respect to ALS or other conditions where the body is sound but the mind is not and the person may not be able to express the issue of consent. Again, I think the key is the particular regulatory framework that is put around the issue of advance consent.

Clearly, a person, knowing that at some point in the future he or she will be losing his or her mental capacity, would have to have expressed it extremely clearly in an unreserved fashion that would ultimately meet the regulatory framework set out, with two physicians concurring that in fact consent was given in an express manner, and setting out the clear guidelines, the clear situation in which he or she would be prepared to be administered with medically assisted death.

If we could create that kind of a framework, I think that would address the concern the hon. member may have.

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

Madam Speaker, my hon. colleague from Scarborough—Agincourt has a very thoughtful approach to this issue.

I am in the enviable position of knowing that while not all of my constituents support this bill, most of my constituents support this bill, because they have been waiting a long time to see compassion in medically assisted death. I particularly want to commend my colleague for voting on this bill, knowing that the comments he has heard from his constituents go the other way.

I want to give him a little more time to share with us what he plans to say in further convincing his constituents that what he has done is required under the Charter of Rights and Freedoms.

[Arnold Chan, Liberal, Scarborough—Agincourt, ON]

Madam Speaker, I want to get to my final point which is personal.

Not only am I a member who has to decide as a parliamentarian, but I am also a member who was recently diagnosed with recurrent cancer. I may in fact be someone who may have to, potentially, depending on how treatment goes, avail myself of this option. It is not one I would like to contemplate, not one that I think is a choice I would like to make, but it is a practical reality of something I might have to face.

We simply have to have an honest conversation with our constituents. In fact, I commend my colleague from Victoria, who has offered to come and do a joint presentation in my riding to explain the practical realities of this bill. At the same time, we need to hear from Canadians and understand why they have objections.

At the end of the day, the point I want to make is when there is not societal consensus on a particular issue, we ultimately have to make sure that any bill that is put before us is constitutional and does not trample on the rights of individual Canadians.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, before I participate in the debate at second reading on Bill C-14, concerning medical assistance in dying, I want to tell the people faced with making difficult end-of-life decisions and their loved ones that I am thinking of them.

Everyone knows that medical assistance in dying is a complex, delicate, and extremely personal issue. Since the Supreme Court ruled in the Carter case last year, Canadians have been taking part in this national debate. This issue continues to be debated and seriously considered around the world.

I would like to share with my colleagues what is happening elsewhere in the world. Almost everywhere, the deliberate taking of a life or aiding someone to end their life are serious crimes punished by lengthy sentences. As many people know, Canada is not alone in legislating to authorize medical assistance in dying.

Oregon, Washington, Vermont, and California are examples nearby. A little further away, Colombia, Belgium, the Netherlands, and Luxembourg have legislation authorizing one type or another of medical assistance in dying. The provisions on safeguards, controls, and reports, which are all found in Bill C-14, are similar.

Usually, requests for medical assistance in dying must be voluntarily submitted by the patient in writing. In many cases, this must also be done in the presence of independent witnesses. The patient must obtain a second opinion from an independent doctor and must wait a certain amount of time between the day the written request is submitted and the day that the medical assistance in dying is provided.

Colombia has a unique approval process for requests for medical assistance in dying. Every hospital has interdisciplinary committees to assess such requests and support the patients and their families throughout the process.

Nearly all of the regimes we have looked at include a mandatory monitoring system in which independent committees collect information to monitor the situation. That information is then used to publish periodic public reports on medical assistance in dying.

The safeguards and controls set out in various statutes are relatively consistent. However, there are differences in the types of medical assistance in dying that are authorized and the circumstances in which medical assistance in dying is authorized. The differences in terms of who is eligible for medical assistance in dying and the way that assistance can be provided fall along a continuum.

On the one hand, we have the four U.S. states, which I mentioned earlier and which have enacted laws: Oregon in 1997, Washington in 2008, Vermont in 2013, and, more recently, California in 2015. In these states, a mentally competent adult 18 years of age or older can receive the assistance of a physician to die, provided that their request is voluntary and this person is suffering from a terminal disease, defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.

In these U.S. states, just one doctor may prescribe a substance that the patient administers to put an end to their life at the time of their choosing. This is what we commonly refer to as physician-assisted suicide. Voluntary euthanasia, in which the physician administers a substance that causes the death of the patient, is expressly prohibited. Patients are also not able to submit an advance directive.

In Colombia, a ministerial resolution was drafted in response to two rulings by the country's constitutional court. The resolution contains eligibility criteria similar to those of the U.S. states.

It limits eligibility to adults who have an incurable disease, which is defined as a serious, progressive, and irreversible disease, or a pathology that will lead to death within a relatively short time frame. It requires a specific prognosis of six months, in other words, the assurance that death is expected relatively soon. Unlike the U.S. states, Colombia authorizes only euthanasia. A doctor must administer the substance that will cause the patient's death.

At the other end of the spectrum are Belgium, the Netherlands, and Luxembourg. In those three countries, patients can access medical assistance in dying if they are experiencing intolerable or unbearable physical or mental suffering caused by a serious incurable illness and if there is no possibility of improvement. Patients do not have to be dying or suffering from an illness that puts their life in danger in order to be eligible. In other words, physician-assisted suicide and voluntary euthanasia are authorized in those countries.

Although medical assistance in dying is provided only to adults in Luxembourg, minors as young as 12 can seek medical assistance in dying, with their parents' consent, in the Netherlands. In Belgium, adults and emancipated minors can seek medical assistance in dying in similar circumstances. In 2014, Belgium expanded its eligibility to include children of all ages, but only if their death is likely to occur in the short term and their suffering is physical.

The experiences and lessons learned by the Benelux countries were closely examined. For example, the law in the Netherlands authorizes requests for patients who no longer have the ability to express their wishes. However, research suggests that doctors are generally not prepared to euthanize such patients.

Consideration was also given to the Benelux countries' experience regarding patients who are suffering intolerably solely because of a mental illness. This is a very controversial issue. Evidence shows an upward trend in the percentage of people who seek euthanasia solely because of mental illness, and experts are starting to express their concerns about the fact that medical assistance in dying under such circumstances is becoming increasingly common. For example, in Belgium, people have been euthanized because of intolerable suffering resulting from depression, anorexia, blindness, fear of a disability or further suffering, and the pain caused by the lost of a loved one.

Many people fear that such broad access to medical assistance in dying can present real risks for people who are lonely or isolated and those who do not have any social, economic, or community support. It could also reinforce prejudice regarding the quality of life of seniors, people who are sick, and people with disabilities.

Our government sought to learn from the experience of other jurisdictions. The government is committed to continuing to examine the more general issues, and it will continue to observe what is being done elsewhere in the world in terms of medical assistance in dying.

I support Bill C-14, which was introduced by our government. Once this bill is passed, it will alleviate the suffering of those covered by its scope and will allow people to die with dignity.

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

Madam Speaker, one thing my colleague intimated early in his speech was the number of countries that allow physician-assisted suicide. There is sometimes a misconception that most countries do allow physician-assisted suicide. The reality is that less than 3% of the world's population live in areas where physician-assisted suicide is accessible.

I have a question, though, regarding the terminology being used in this bill, “medical assistance in dying”. There is no clear demarcation between physician-assisted suicide and voluntary euthanasia. Part of that, I think, is because we like the softer language of the current bill, but the more important distinction is that in a regime that has physician-assisted suicide, the results are that only 0.3% of all deaths are attributed to physician-assisted suicide. In regimes that have voluntary euthanasia, it is 3.0%, a tenfold increase in the number of deaths resulting from a system with voluntary euthanasia.

I am wondering if my colleague would agree to include an amendment in the final bill that would say that wherever possible, where the patient is able to, it must be physician-assisted suicide, so that the patients themselves must administer the drug that the doctor prescribes.

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, I would like to thank my colleague for his question.

My colleague spoke about certain statistics and data, which I appreciate. I say that with all due respect and without any sarcasm whatsoever. However, this is not about ratings and assessing the numbers and the data. This is about human suffering. We should not lose sight of the fact that this exercise is made necessary by a Supreme Court ruling based on the charter. The current situation is no longer acceptable.

The purpose of my explanation was to show that there are situations where countries have been much more permissive and we have major concerns. In other situations, countries have been far less permissive, and now there are questions. We tried to do something that addressed the problems raised by the Supreme Court, while dealing with the information that we have before us, which is about human suffering.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Madam Speaker, today's debate is critical. It is extremely important. It affects everyone, and it gives rise to both hopes and fears in our communities.

The NDP thinks that we need to listen to the experts, and it also wants the government's bill to measure up to the Supreme Court's decision in Carter. Right now, we have some concerns about that. For example, in paragraphs 13 and 14, the Supreme Court talks about the cruel choice that patients with degenerative diseases face. Will they put an end to their life right away, or will they wait until they are no longer able to do so?

The all-party committee made a recommendation that patients be allowed to make an advance request regarding their end of life when they know that their situation is irreversible. Unfortunately, the recommendation from the all-party committee was not included in the government's bill. Would my colleague agree to add this recommendation to the bill in order to improve it?

[Nicola Di Iorio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, I thank my colleague for his question.

There is one thing I must point out that is very meaningful. In life, we are all faced with choices, and we make these choices, but when the time comes to act on our choices, we have the option of changing our minds. We often exercise this right.

In the situation my colleague mentioned, the individual could not change their mind. That is why the government chose not to accept this recommendation. Someone makes a choice, but when the time comes to act on it, no one can ask them whether they have changed their mind or are reconsidering their decision.

People are autonomous and the choice is theirs to make. The government decided to accept that choice.

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

Madam Speaker, I cannot tell you how privileged I feel to take part in this discussion, and I mean “discussion”, because in the course of our work, which went on until midnight last night and will do the same tonight, it really has been a discussion, with the goal of coming up with the best possible solution, and not a partisan debate.

These kinds of subjects come up very rarely in history, and when the time comes for me to leave politics, I will look back on this as one of the most memorable topics of discussion in my time here.

In studying a bill, we must of course take a rational and intellectual approach, based on facts and science; however, with this kind of subject, we cannot ignore our personal experiences and, for many of us, the dimension of faith that goes along with life and quality of life.

Just a few decades ago, it would have been unthinkable for us to have a debate on the issue raised in Bill C-14. Today, this discussion is essential in order to address the concerns many Canadians have about quality of life.

Our society is constantly evolving, and for obvious and sometimes valid reasons, our democratic institutions will always be partly out of step with popular sentiment. However, the wishes of the majority should not be the only factor that guides us in our decision-making, because if our democratic institutions do not protect minorities, I wonder who will.

There are some historic issues that stand out in the life of a parliament, and as a result of the Carter ruling, we are now being called on to deal with such an issue. Although we are aware that there is little time left to deal with such a vast and also complex issue, we nevertheless have the good fortune of being able to refer to the Quebec experience, which quite surely can be a source of inspiration and can answer many of our questions.

Today, armed with the Quebec experience, our personal experiences, and input from many organizations and people in our respective ridings, we are being called on to make the best possible decision about how to provide medical assistance in dying. This is not about whether or not this assistance should be available.

The Supreme Court made that decision in Carter. As we all know, it was a unanimous ruling that sent a clear message on behalf of those who have spent years fighting for the right to die with dignity. It is up to us to legislate a framework for that assistance in a way that ensures respect for everyone's charter rights.

The bill is far from perfect, but at this point, I plan to vote in favour of it so that we can have the opportunity to perfect it by suggesting useful amendments during the committee's study.

I would like to share a very personal experience because I think that is the best entry point with this issue. Until recently, I was spared any major health problems, but not long ago, when I had a kidney stone that was relatively benign and easily treated, I had to cope with waiting six hours to get a drug that would alleviate my suffering.

When I shared my story with a few people I know, several of whom had had similar experiences, I saw how quickly people responded to suffering with sincere compassion.

Although this was a relatively minor health problem, for the first time, I felt, in my own body, the pain that may have been felt by my own parents, who both died of cancer. I spent as much time as possible with them when they had to move into a hospice. There is no doubt that their suffering was enduring and intolerable and that their health problems were grievous and irremediable. They met all of the criteria set out by the Supreme Court.

The workers in that hospice understood and still understand that no one should have to suffer while they are waiting to die when there are ways to relieve their pain, even though, in many cases, one of the side effects of the drugs is to precipitate death.

I have to say that when I remember the relief that I saw on my mother's and father's faces, I am inclined to support this bill and try to improve it.

This bill should be accompanied by a real national strategy on palliative care. In my opinion, some or all of the $3 billion that the Liberals promised for home care during the election campaign should have been included in the most recent budget. However, that is not the case.

Cancer can strike at any age and often there is no hope of recovery. Many other diseases produce similar effects of enduring and intolerable suffering without necessarily being life-threatening.

That is why I am also concerned about the fact that in this bill, the government did not use the wording in the conditions set out in the Supreme Court's decision. The Supreme Court basically said that Canadian adults who are able to consent and who have a grievous and irremediable medical condition that causes enduring suffering that is intolerable to them have the charter-protected right to physician-assisted death. That is the crux of the Carter decision, which gave rise to the bill that is before us today, Bill C-14.

What is the government trying to do today with this fourth criterion that it added, whereby the natural death has to be reasonably foreseeable? I have to admit to the House that in my mind at least, this is confusing. The terms are hard to define, the likely commendable goal being to seek the broadest consensus, even though that consensus already exists. If not, we would not be debating this bill. The Supreme Court likely would not have ruled the same way either if it had not sensed the evolution of this society.

We are about to undermine the process with such a vague and mandatory criterion because the legislation tells us that to have access to medical assistance in dying, the person absolutely must meet the four criteria set out in the legislation. The first three criteria are easy to understand, but the fourth is exceptionally vague.

I hope to see this fourth criterion disappear during our discussions in committee. With it, we are about to force those who are suffering to again demonstrate the unconstitutionality of the legislation, leading us right back to where we are today. We are here now, so let us see the work through and do it properly. Let us agree to ensure that this bill complies with the Constitution, that it will not be challenged later, and that those who wish to use it can finally do so.

Other questions remain practically unanswered, which is why the work coming up in committee after the bill passes second reading, I hope, is so important. As we point out in our supplementary opinion attached to the report, the government must adopt an approach to legislating medical assistance in dying based on the following principles: protecting vulnerable persons; taking into account the ethical concerns of all medical professionals; guaranteeing equal access to medical assistance in dying; protecting the conscientious objection of health care professionals; and respecting jurisdictions.

My time is running out, so I will conclude by saying that the NDP's job is to clarify the ambiguous provisions in the bill, strengthen the bill to avoid charter challenges, and demand stronger commitments with respect to palliative care and mental health care services to protect the most vulnerable Canadians. I can sense this in listening to my colleagues and all members of this House.

I am prepared to take questions from my esteemed colleagues.

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

Madam Speaker, I would like to put a different twist on this. We have heard a great deal about another component: the issue of palliative care. There is merit to getting further insight and comments on the record with regard to that.

I know the member's background and, in particular, his political affiliation. Recognizing that the leadership in Ottawa needs to work with different levels of government to get something of equal value in every region of our country, I am wondering of the member would provide his thoughts on the importance of investing in palliative care. We might find situations where people make this decision, and one thing they take into consideration, no doubt, is what sort of palliative care there might be. Would the member like to comment on that particular issue?

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

Madam Speaker, I thank my colleague for his question.

Several aspects of Bill C-14 blur the line between federal and provincial health jurisdictions. As soon as we start talking about palliative care, we are talking about health care, which is a provincial jurisdiction.

Nevertheless, the federal government can still take a leadership role, especially with its health transfers, so that Canadians across the country have equal access to palliative care as part of the end-of-life care continuum. Naturally, this must be done in accordance with the provincial and territorial legislatures.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Madam Speaker, it is kind of funny to hear government members say that palliative care is a priority for them considering that there is nothing for palliative care in the budget.

Can my esteemed colleague help us figure out what is going on?

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

Madam Speaker, I thank my colleague for his question. Unfortunately, my response will sound a little partisan, which is what I hoped to avoid on this issue.

That is the kind of response the government has been offering up since coming to power six months ago. The government members went on and on about middle-class tax cuts, but the cuts will not help anyone who earns $45,000 or less. Those people are still not part of the middle class.

They say one thing but do another. What do people remember? Actions. During the election campaign, the Liberals promised to invest $3 billion in home care, which includes many different services. I am sure some of that money could have been allocated to palliative care and incorporated into this bill.

Of the $3 billion that was promised, not a penny showed up in the latest budget for any kind of home care. They seem to have postponed this important element. We have an aging population in Canada and Quebec, and we need to tackle these crucial issues.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I cannot say I am pleased to join this discussion, because I think it is an issue that is very difficult for all of us as parliamentarians, as Canadians, to deal with these very sensitive issues. However, I do want to begin by thanking the constituents of Humber River—Black Creek where many took the time to call or to write my office on the issue, or come by to see me, many in tears, talking and relating to episodes within their own family and their worries about what Bill C-14 would actually mean. As always, I appreciate my constituents' thoughts and the fact that they have taken an active role in what happens here because they understand that the debate here is going to impact on many of their lives.

As might be expected, the issue of medical assistance in dying is one that is difficult for many. The question is deeply personal, emotional, and even spiritual, and I understand and appreciate the concerns and challenges many have with the subject matter before us.

I, too, have struggled with these decisions, as have others. For example, I was deeply concerned when I was first confronted with the report of the Special Joint Committee on Physician-Assisted Dying. In particular, one of the areas I was concerned about was the idea that minors might be able to attain medical assistance in dying. I was also concerned with the notion that doctors who, for legitimate issues of faith or conscience, oppose medical assistance in dying might be forced to participate in this process contrary to their personal beliefs. Both of these things would have made the bill clearly unacceptable to me.

Fortunately, Bill C-14 attempts to address these issues by seeking to find a balance in this legislation, the best approach to ensure that dying patients who are suffering unbearable pain have the choice of a peaceful death and that the vulnerable are protected. I still question whether we have done the very best job we could do. I know the committee worked very hard at this and spent many hours listening to people. I guess I am still looking to see if we can make it better. However, I have to acknowledge the extremely tight timelines we are under, and the House must contend with those deadlines or we will have no protection for anyone.

The Supreme Court decision and the parliamentary timelines over the past year have combined to thrust us into this time crunch that none of us would have preferred to be in. This does not change the fact that we are here now. Nor does it change the fact that the defeat of Bill C-14 would mean the current prohibition on medical assistance in dying would end. The fact is that the Supreme Court unanimously decided that Canadians suffering intolerably have the right to request assistance to end their suffering.

The issue before us is not if, but how, we do this. This is not a political issue for me, and I do not believe it is a political issue for anyone in the House. Like my colleagues, I have looked at this matter as a person, a daughter, a mother, a grandmother, and someone who has watched many friends grapple with the complex, costly, and emotional challenges connected with terminal illness.

Palliative care, parental leave, family leave, and home care, while not directly contained in Bill C-14, must be part of the discussion, and they are. As I listen to the debate, it is clear that the matter is one that members are contemplating in a holistic way. I am pleased to hear again as part of the debate on this legislation that the government is committed to supporting quality end-of-life services and will continue to work with provinces and territories to improve palliative care for everyone. That means we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying. This helps to assure us that the government's approach is one of caution, one that is seeking a balance.

I also need to acknowledge the parliamentary secretary's verification that the government will work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, while respecting the personal convictions of health care providers.

This is important because it would ensure that the concerns raised by many within the medical community would be addressed.

I mention this for a key reason. Canadians want religious freedoms to be protected for all Canadians, including doctors. Canadians also expect their government to respect and defend the Charter of Rights and Freedoms. Bill C-14 would attempt to do this while putting safeguards in place to protect the vulnerable as well.

Again, the Supreme Court of Canada unanimously decided that Canadians who are suffering have the right to medical assistance in dying. This means that the issue before us again is not if but how. After extensive consultation and extensive work by the committee, the government is proposing a framework that considers different interests, including personal autonomy toward the end of life, the protection of vulnerable persons, and the rights of conscience.

Access to medical assistance in dying, as envisioned under Bill C-14, would be available only to those who meet these conditions: mentally competent adults who are in an advanced state of irreversible decline in capability; who have a serious and incurable illness, disease, or disability and are experiencing enduring and intolerable suffering caused by their medical condition; and who have deaths that have become reasonably foreseeable, taking into account their condition.

For me, this is not just a discussion about the extension of life, nor should it be exclusively a decision about prolonging one's death. In instances where the end of life is near, the court has spoken and Parliament must now step up. If we fail to take action, we know the consequences, so doing nothing is not appropriate.

In order for me to support Bill C-14, I need to be assured of the government's firm and unwavering understanding that it will continue to support quality end-of-life services and will work with provinces and territories to improve palliative care. Again, end-of-life care is not just about medical assistance; it is about so many other things.

We have to remember Dr. Low in Toronto and his appeal by video to end his own life. We remember Sue Rodriguez. We remember all of those. Do I have a right to decide who dies and who lives, or that someone should endure the kind of pain that many are suffering? What would I do if my husband had ALS and begged me to end his life because he could not stand the pain? Do I have the right to say no? However, I also believe that it is God's right to call us all.

Bill C-14 is attempting to deal with a very difficult issue for all of us and for Canadians. Let us get it to committee. Let us see if we can make it stronger and make it better so that we are putting the emphasis on the palliative care and on the kinds of drugs that would eliminate the pain and make people more comfortable, so that none of us will have to make that decision.

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

Madam Speaker, I listened intently and I want to thank the member for her speech. She brought up Dr. Don Low who was a microbiologist who died from brain-stem cancer. She mentioned his suffering. In fact, he was not in pain and he died in the arms of his wife eight days after making that video. However, he would have qualified because he was at end of life. He was not physically suffering, but he was suffering and when we asked what was the suffering, it was that he had lost control of bodily functions.

We heard last night at the justice committee that somebody who is in an adult diaper who is suffering dementia is seen as somebody in a pitiful state. My mother-in-law, a wonderful person, had dementia and was in a similar state but I did not see her as pitiful. Would the member see somebody who has dementia and is in an adult diaper as suffering and being in a pitiful state?

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, they might be in a pitiful state. However, that does not mean that one would end their lives because they are in a pitiful state. In our eyes, there are a lot of people who are in a pitiful state when we look at them. However, nobody says that they necessarily want to end their lives. We may not like to see them suffering and reduced to a pitiful state, as the member called it, but they do not necessarily see that. Therefore, what we are trying to do is find that balance.

I hate the idea that anyone would be in such pain that they would ask to have his or her life ended. I would like to make that person as comfortable as possible and help him or her in every way we humanly can. I do not want to see a whole lot of people saying that their lives are miserable and that they want to end them. There are a bunch of conditions in Bill C-14. They would have to get two opinions. There is a whole list of things. Therefore, it would not be done casually. However, it is all in the eye of the beholder.

I do not want to make this easy, and I do not think Bill C-14 does that. It is trying find a balance that is fair for people to be able to make a decision if they are in a horrific situation. My seatmate may be in that situation.

What would the member say if he was asked and the person fit the conditions? I am not sure.

[Sheri Benson, NDP, Saskatoon West, SK]

Madam Speaker, I want to thank my hon. colleague for her comments and her openness to look at and share the fact that we do need to move forward on the how, and that the government needs to be open to amendments and ensure that what we find at the end is compliant with the case so that people can move forward in a good and positive way.

The member also commented on people sharing their beliefs and views. Of course, I have had those in my office as well.

One thing that is important to me, and I would welcome her comments on, is including provisions to protect health care providers. For many people it is a faith-based decision. We need to protect their rights and ensure that this is included in the bill so that those folks, and the people who are supporting them, feel comforted that it is there and their rights are protected.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, certainly a fundamental part of the bill is rights and freedoms for everyone, including those in the medical profession who would be asked to assist people who qualified under the conditions of Bill C-14; with respect to those aspects of it they would have to be. However, they have rights to be protected as well, and the bill has to ensure that it is protecting the rights of our medical professionals.

Message from the Senate

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Before resuming debate, I have the honour to inform the House that a message has been received from the Senate informing this House that the Senate has passed Bill S-208, An Act respecting National Seal Products Day, to which the concurrence of the House is desired.

The House resumed consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the second time and referred to a committee, and of the motion that this question be now put.

Criminal Code

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, it is always a pleasure to stand in the House to debate the issues of the day, although this is not one that I would have ever chosen to debate in the House. It has been debated before a number of times. Each time it was defeated, and each time it brought me a certain degree of relief when it was.

I want to thank the many constituents of Battle River—Crowfoot who have contacted me about the issue of doctor-assisted suicide. This issue has been raised a number of times, as I said, and every time my constituents have been very vocal in their opposition to making assisted suicide available.

There are some who disagree and are willing to support efforts to make assisted dying available in very limited circumstances, but the vast majority of my constituents in Battle River—Crowfoot, and, I dare say, most Canadians, do not want to unleash doctor-assisted suicide on our country. Why? It is because we have seen what has happened, to be quite frank, in other countries, how it started, and where it is now. I am not sure if we are going down any different road.

One of constituents from Bashaw, Alberta, sent me a letter and a paragraph in that letter sums up how things seem to be going. I will quote what was said. The letter states:

We want students to make responsible decisions for themselves about all manner of things from sexual activity to career choices to not inflicting self-harm. At the same time, we tell them they are only advanced animals with no eternal purpose. On the reserves, especially, we talk about our respect for the Elders and then as a broader society we discuss how we can help our elders kill themselves. We encourage youth to stay away from drugs and excessive alcohol consumption. Then we discuss how to legalize marijuana.

Here we are today with the Liberal government forcing us to pass a law that would legalize doctor-assisted suicide. We should be talking in the House about palliative care and end-of-life treatment. Did we hear that or see a line item in the budget? No, not a mention.

We should be providing funding to improve and provide palliative care to our aging population in our cities and rural communities. The previous Conservative government started the consultation. After the Carter decision, many submissions were made by Canadians. It is a difficult issue in households across Canada for families who face this and confront the issue. It is a very controversial and highly emotional issue.

Many Canadians believe that the Supreme Court's decision in the Carter v. Canada case is another instance of judicial activism. That was stated in many of the letters received by my constituency office. The court struck down the criminal laws against physician-assisted dying. Many Canadians supported the laws against doctor-assisted suicide. There was a very small group asking for this, the smallest of minorities, but the Supreme Court gave these special interest groups what they wanted.

I believe the Liberal government has shirked its responsibility to educate Canadians on what we are debating. There has not been enough consultations with individuals, groups, and experts. Even today, in the midst of this debate, which has been a good debate, the Liberals tried to shut down the debate. The Liberals have not taken into account a range of interests in Bill C-14, such as those advocating religious freedom. The previous speaker talked about the conscience rights of physicians and health providers and many are advocating for safeguards to protect the vulnerable. This bill is not a compassionate approach that considers all pertinent interests.

I do not believe the Special Joint Committee on Physician-Assisted Dying did a sufficient study. Quebec studied this issue for six years. Other countries studied it for years. However, the court has given Canada only a matter of weeks of study. The committee did not study what happened in other jurisdictions where we have seen this brought forward. The special joint committee heard from pro-euthanasia lobby groups. It had some of the pro-euthanasia groups appear on three separate panels.

[An hon. member]

Three times.