House of Commons Hansard #47 of the 42nd Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was death.

Topics

Question No. 78Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

Conservative

John Nater Conservative Perth—Wellington, ON

With regard to federal spending within the electoral district of Perth—Wellington for each fiscal year from 2011-2012 to 2015-16, what is the list of grants, loans, contributions and contracts awarded by the government, broken down by (i) department and agency, (ii) municipality, (iii) name of the recipient, (iv) amount received, (v) program under which the spending was made, and (vi) date?

(Return tabled)

Question No. 79Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

Conservative

Blaine Calkins Conservative Red Deer—Lacombe, AB

With regard to the government’s decision to resettle 25 000 Syrian refugees, what is: (a) the total dollar value being disbursed to each refugee upon arriving in Canada; (b) the total dollar value the government is providing each refugee on a monthly basis; (c) the anticipated end date for the government’s financial assistance to each refugee; (d) the monthly cost for all refugee temporary housing; and (e) the cost of any and all subsidies provided to Syrian refugees once placed in permanent housing?

(Return tabled)

Question No. 82Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

NDP

Guy Caron NDP Rimouski-Neigette—Témiscouata—Les Basques, QC

With regard to the Natural Sciences and Engineering Research Council of Canada’s PromoScience Program, for 2015: (a) which organizations received funding; (b) how much did they receive, in total and broken down by organization; (c) where are these organizations located, broken down by city?

(Return tabled)

Question No. 83Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

NDP

Niki Ashton NDP Churchill—Keewatinook Aski, MB

With regard to the government's use of temporary help services and contracts: (a) what companies are contracted by the government to provide temporary help services, broken down by department and agency; (b) what is the average length of employment for temporary workers, broken down by department and agency; (c) what mechanisms does the government use to track the work done by contractors across government departments and agencies; (d) how many temporary staff were hired by the government, broken down by (i) province and territory, (ii) year, from 1999-2000 to present; (e) how much is disbursed by the government on average for (i) temporary staff, in terms of annual full-time equivalency, broken down by classification, (ii) permanent staff, in terms of annual full-time equivalency, broken down by classification; (f) what is the percentage change in expenditures for temporary help services and salary costs for indeterminate, term, and casual employees from 2008-2009 to 2014-2015 (in unadjusted dollars, reference 1999-2000); (g) what were the reasons given for engaging temporary help services, broken down by year, beginning from 2007-2008; (h) what were the percentages of contracts allocated for temporary help services for each cost range of less than $20,000, between $20,000 and $60,000, and more than $60,000, broken down by (i) reasons for the hires, (ii) year, beginning from 2007-2008; (i) what is the average age of temporary staff hired, broken down by (i) region, (ii) department or agency, (iii) classification?

(Return tabled)

Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

Liberal

Kevin Lamoureux Liberal Winnipeg North, MB

Finally, Mr. Speaker, I would ask that all remaining questions be allowed to stand.

Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

Liberal

The Speaker Liberal Geoff Regan

Is that agreed?

Questions Passed as Orders for ReturnsRoutine Proceedings

10:10 a.m.

Some hon. members

Agreed.

The House resumed from May 2 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.

Criminal CodeGovernment Orders

10:10 a.m.

Northumberland—Peterborough South Ontario

Liberal

Kim Rudd LiberalParliamentary Secretary to the Minister of Natural Resources

Mr. Speaker, I am here today to talk about an issue that touches the lives of every Canadian—how we die. It is not an issue we usually like to discuss, but with the Supreme Court's decision in the Carter case, it is now at the forefront of our government's political and health agenda. On February 6, 2015, the Supreme Court of Canada unanimously declared that the criminal court prohibitions on physician-assisted dying were constitutionally invalid. Changes will come into effect on June 6 of this year. All governments are preparing to respond.

Consultations with the public have made it clear that there is extensive support for the provision of medical assistance in dying. An Angus Reid research poll that was published earlier this month found that 90% of Canadians surveyed think that some form of assisted dying should be allowed. The government takes the Supreme Court of Canada decision seriously.

It is a deeply felt and sensitive issue for all Canadians, and we understand it is essential that implementation of this new legislation be undertaken with careful consideration. That is why the government has developed a framework based on empathy, appropriate protections for vulnerable Canadians, and the need for choice. Careful consideration has been given to the eligibility criteria, substantive and procedural safeguards, and recommendations for monitoring and reporting.

I also want to make it clear, however, that medical assistance in dying is not to be the only choice for a peaceful, dignified death. No matter where people stand on the issues surrounding medical assistance in dying, they all agree that we must improve palliative care. Palliative care is a multidisciplinary approach to health care for individuals and families who are living with a life-threatening disease as well as other conditions. It focuses on improving quality of life through the prevention and relief of physical and psychological suffering, with treatment plans tailored to the needs of the patient and the family.

Reports about the status of palliative care in Canada suggest that the delivery of and access to palliative care and hospice care varies greatly across Canada. This is due to differences in regional demographics, societal needs, organization of health care services, and levels of funding.

When asked, most Canadians indicate that they would prefer to die at home in the presence of loved ones. There is clearly a need to bridge this disconnect and for all levels of government to support the needs and desires of Canadians at the end of their lives to receive the most appropriate, timely, and compassionate care. The gaps in palliative care have been raised repeatedly over the years by a number of organizations. It is very clear that Canadians are looking to their governments for leadership to close these gaps.

In the past, palliative care in Canada has been delivered primarily in hospitals by specialists, and largely to cancer patients in the last stages of their illness. While many people still associate palliative care with hospitals and cancer patients exclusively, it can be delivered to a variety of patients and in different settings, including long-term care facilities or even one's own home.

It is estimated that the health system is currently unable to provide palliative care to 70% of those who could benefit from it. This is why our government is taking immediate steps to address this gap and work with the provinces and territories so that more Canadians have access to the care options that are right for them when they need them.

The government is currently funding the Pallium Foundation of Canada to support training in palliative care to front-line health care workers, and this initiative is complementing a previous initiative called the way forward. This is aimed at integrating a palliative-care approach throughout the health care system and across a range of providers and settings.

The federal government has also supported a number of initiatives to improve public awareness: health care professional education and training, national best practices, and standards and research. Federal investments in research also expand the depth and breadth of understanding of end-of-life-care issues and how best to address them.

Recently, the federal government provided $14 million over two years for the Canadian Foundation for Healthcare Improvement to support applied health services research, as well as the foundation's work to identify savings and efficiencies in the health care system, including a palliative care component. In budget 2016, the government also committed to making compassionate care benefits easier to access, more flexible, and inclusive for those who provide care for seriously ill family members, and more flexible parental leave benefits to better accommodate unique family and work situations.

As with other health care services, delivery of palliative care is mainly the responsibility of the provinces and territories. While each province and territory has some level of palliative care services, with some moving ahead with frameworks or strategies, there are wide variances both within and between jurisdictions. Many are focusing on integrating palliative care with other types of care across settings and services. However, Canadians' ability to access palliative care remains mixed, depending on where one lives.

The Government of Canada has committed to developing non-legislative measures that would support the improvement of a full range of options on end-of-life care. In the discussions with provincial and territorial governments toward developing a new health accord, our government has committed to provide $3 billion over the next four years to improve home care, including palliative care.

I firmly believe my own experiences with end-of-life care are not unique from those of thousands upon thousands of Canadians. Losing my grandfather John, my mother, Gaye, and my Aunt Babs is something that has never left me. These people were titans in my life. My mom and Aunt Babs taught me everything I know about being passionate and determined, about giving of oneself to others, and about what it means to be a woman. They both had such a profound effect on every day of my life. I am here totally because of their legacy of excellence.

Both of these women, who were so strong and committed to family and community, were so harmed as human beings by diseases that ravaged them. I learned what it meant to sleep on the floor day after day because they were afraid to be alone. I learned how to administer morphine and Ativan and that, if they even whimpered, I was to give more, as that meant they were still being torn apart inside.

I learned how to raise or lower a home hospital bed. I learned how important palliative care is, to have access to it, but these are things I wish I had never had to learn. From all of them, I learned in those last days that there was no peace; there was only pain. There was no dignity, only terrible uncertainty. There was not nobility in their suffering. I learned pity.

I am proud to stand in the House today and express my support for this critical piece of legislation. Not only does it respond to the decision by the Supreme Court of Canada in terms of amending the Criminal Code, but it also provides an excellent framework to facilitate the necessary changes to our health care system, which responds to this decision.

Our government has listened to Canadians. Our government has listened to the experts. We have developed an approach that we believe reflects this input. It is now time to move forward with this legislation so that individuals, families, and health professionals have more options for end-of-life care, including medical assistance in dying.

Criminal CodeGovernment Orders

10:20 a.m.

Conservative

Dianne Lynn Watts Conservative South Surrey—White Rock, BC

Madam Speaker, I want to thank my colleague for her gracious words in describing what she has gone through. As she said, many people have gone through those tough times.

I have a question. The minister, yesterday, stood in the House and stated that there were $3 billion for palliative care, yet there was nothing in the budget. I am wondering if the member can explain where those dollars will come from and how they will be allocated.

Criminal CodeGovernment Orders

10:20 a.m.

Liberal

Kim Rudd Liberal Northumberland—Peterborough South, ON

Madam Speaker, the budget did indeed include $3 billion for home care. As the member may know, the minister has spoken a number of times in the House about her negotiations with the provinces and territories regarding how this framework for health care in general across Canada will be determined.

As I said in my speech, it is the prime responsibility of the provinces and territories and our responsibility as a federal government to work with them to find the best way forward for individuals in the provinces and territories.

Criminal CodeGovernment Orders

10:20 a.m.

NDP

Anne Minh-Thu Quach NDP Salaberry—Suroît, QC

Madam Speaker, I thank the hon. member for her very moving speech on this issue.

In paragraphs 13 and 14 of the Carter decision, the Supreme Court of Canada referred to the cruel choice faced by patients with degenerative disease. Under the government's current bill, those patients cannot provide advance directives. They have to choose between taking their lives prematurely or suffering for the rest of their lives because they cannot satisfy the conditions under which they could have access to medical assistance in dying.

Why did the government reject this recommendation? Does the hon. member think that this could be amended at committee stage?

Criminal CodeGovernment Orders

10:25 a.m.

Liberal

Kim Rudd Liberal Northumberland—Peterborough South, ON

Madam Speaker, when we look at the Carter decision and the government's response to that decision, it is about finding a balance. As I said in my speech, we listened to Canadians and to the experts. We recognize that June 6 is a very imminent date and that we have found the best solution for now.

As the member may know, there was a commitment to look at three or four further elements, including advance care decision-making. I believe there is a commitment to work on that, going forward. I welcome the work from the member opposite on that issue.

Criminal CodeGovernment Orders

10:25 a.m.

Liberal

Lloyd Longfield Liberal Guelph, ON

Madam Speaker, we have had many comments in the House that the government has not gone far enough with Bill C-14 in being prescriptive about how it would be applied to the different types of medical institutes that are provincially regulated. They are similar to comments about how we would apply climate change legislation provincially, when provincial governments have already started the work on this.

In light of what Quebec has done already in terms of applying this, could we have a comment on the role between the federal and provincial governments in applying this legislation?

Criminal CodeGovernment Orders

10:25 a.m.

Liberal

Kim Rudd Liberal Northumberland—Peterborough South, ON

Madam Speaker, there is a very strong role for the federal government to work with the provinces and territories. There are many questions yet to be answered during the discussions with the provinces and territories, and there are best practices around the world that have been examined and will continue to be examined with respect to implementation.

I do not believe that, as a federal government, our role is to be prescriptive. It is to provide the tools to help the provinces and territories build the framework for their own situations. In my speech I talked about the access being different depending on where one lives. Sometimes it is about geography. Therefore, we have to address the multitude of options that will be available.

Criminal CodeGovernment Orders

10:25 a.m.

Conservative

Cathay Wagantall Conservative Yorkton—Melville, SK

Madam Speaker, I am thankful to be able to add my voice to the discussion on Bill C-14, medical assistance in dying.

The Supreme Court of Canada has put what I perceive as an inappropriate timeline on this House in regard to this legislation, because it has come to the conclusion that the Criminal Code of Canada is unconstitutional in making it illegal for anyone to cause the death of another person who consents to die or to assist a person to end their own life.

In speaking with a very concerned constituent last week who was in law school when the charter was enacted, the comment was made that the university law professors of the day assured a troubled graduating class that what is actually happening today would never happen.

We are now in a place where, in attempting to guarantee every person their charter rights and freedoms, we are endangering the rights and freedoms of others. A synergy of wisdom and selflessness is needed in balancing what is perceived as best for me in relation to what is best for others. Just because we can, does not mean we should.

As well, in determining if we should, it seems to me the wise approach would be to look at those who already did, and regret. This would require learning from recent history rather than pretending that what we are doing is somehow progressive, when it has already been proven to be a regressive decision elsewhere.

The Supreme Court has chosen to ignore its own previous decision on the issue, along with six different parliaments that have previously rejected assisted suicide. It appears that the plumb line is not what is best for society and humanity as a whole, but rather what is the latest progressive trend that is putting the strongest pressure on how we live and relate as a society.

I have been a pastor's wife, and a caregiver in hospitals and level 4 care homes. I have worked in a mental illness hospital. I have been an education aid for special needs children in kindergarten and high school students.

I am the daughter of a father with Alzheimer's, the grandmother of a high-achieving grandson with autism, and I have a loved one who is suffering with mental illness. I, too, am well aware of life's challenges. My personal belief is that life is sacred from conception to natural death, and the protection of the most vulnerable in our society must always be the determining factor in how we choose to govern and make laws in Canada.

This is the expression as well that has been sent to me over and over again from constituents in my riding and across Canada, and today we need to have a debate in this House that is very balanced and presenting all views from all people in Canada.

Life is challenging, and dying, far more often than not, is difficult for the one passing away and in some ways even more so for those experiencing end of life alongside the individual who is dying. I believe there is value in that as well.

The misfortunate reality of Bill C-14 is that it will cause far greater grief than it will appease. Making something legal does not make it morally right. People who request a physician-assisted death can be motivated by a range of factors unrelated to their medical condition. These factors can make some people vulnerable to request assisted death when what they want and deserve is better treatment and palliative care.

It needs to be pointed out that the Belgian euthanasia law does not apply to non-competent patients and it does not allow the deliberate shortening of their lives. The Belgium euthanasia law system, which Bill C-14 mirrors, has been proven to be abused and insufficient to monitor the decision-making process.

For example, the Journal of Medical Ethics published a research article written by Raphael Cohen-Almagor, a human rights activist and chair of the politics department at the University of Hull. His article “First do no harm: intentionally shortening lives of patients without their explicit request in Belgium” focuses mainly on published data concerning the practice of causing death without patient request in Belgium.

The research indicates that the practice remains common, resulting in over 1,000 hastened deaths without request each year, or 32% of the cases of euthanasia. Moreover, in almost half of those cases the doctors refused to report the matter to the overseeing body, despite a legal requirement to do so.

This example clearly shows the legislation is lacking an oversight by an independent third party before the patient is put to death. Sadly, but realistically, the safeguards in Bill C-14 are likely to be insufficient and ineffective in real life conditions.

Furthermore, Bill C-14 applies to those with physical or psychological illnesses who are experiencing enduring and intolerable suffering as a result of their medical condition. Our focus must first be on raising the quality and availability of high-quality palliative care as the humane way to relieve pain, loneliness, and fear for the end-of-life patient and to provide encouragement, direction, and support for loved ones through the natural process of end of life. Bill C-14 does not require a palliative care route be entered upon first, neither does it require the patient to have tried other treatments before requesting medical assistance to die.

As well, I am still deeply concerned for our medical professionals who have contacted me in great numbers who could face severe consequences if they do not assist an individual to take their own life, for whatever reason. No one in our country should be forced to affirm or provide a service that goes against their conscience. The federal government's law leaves this crucial issue for the provinces to deal with, allowing even more interpretations of the general wording.

There should be a structured national system to address the cases when a publicly funded health care organization or separate doctors are unwilling for any reason to provide aid in dying when the patient has requested it.

Furthermore, the bill extends the amendments to the Criminal Code for medical practitioners, nurses, and registered practical nurses. Such an approach is broader than any other jurisdiction in the world and makes it impossible to create a transparent national system.

It is necessary to take into consideration the psychological factors that Bill C-14 would actually influence and encourage. The secularism of our courts affirms a premise that everything is socially constructed, and as a result laws greatly shape the ethos of culture, affecting cultural attitudes toward certain behaviours and influencing moral norms. Medical assisted dying laws send a message that in certain conditions suicide is a reasonable and appropriate way out. The problem is that this message will be received not only by those who have painful, terminal illnesses, but also by those who are tempted to think they can no longer go on.

A study by David Jones and David Paton proved that legalizing assisted dying in other states has led to a rise in overall suicide rates, both assisted and unassisted. This greatly undermines the work of suicide prevention organizations and programs.

As the Conservative deputy critic for veterans affairs and a member of the veterans affairs committee, I believe legalizing assisted suicide would only increase the challenges of providing mental health care and suicide prevention initiatives for those suffering from post traumatic stress injuries.

I agree with my Liberal colleague from Winnipeg Centre who spoke last evening that the government should at the very least postpone legalizing assisted death for at least five to 10 years, until it is absolutely clear what sort of impact it would have in all corners of Canada. His concern is well founded in regard to fighting the suicide spirit that needs to be healed on our reserves in Canada.

Another report in Current Oncology from 2011 summarized that euthanasia in the Netherlands has changed significantly in the 30 years since it was first adopted. It has shifted from medically assisted dying for people who are terminally ill to those who are chronically ill, from physical illness to those who suffer from mental illness, and then to those who suffer the psychological distress of mental suffering, and now to euthanasia of those over 70 who are simply tired of living.

The culture now is that euthanasia becomes expected while palliative care and functional hospice is gradually portrayed and felt to be “selfish”. That is a quote from the UK Daily Mail on September 24, 2013.

This implicates that the bill would not only affect those making a rational and deliberate choice to end their lives, but would also have a significantly wider impact on those who are required to provide such a service or their privilege and right to work in the medical field could be challenged, and also on wider social groups as a whole.

When facing a choice, which we are with the bill, where should the priority for us as legislators be? The imposition by the Supreme Court of Canada to invoke such controversial legislation, which is proven to be failing in other countries; the approach of the committee to manage witnesses and to make recommendations that go far beyond the Carter decision; and the need to first of all institute high-quality palliative care as an intrinsic value and an actual clear priority of the government are all valid reasons that I feel I cannot support Bill C-14.

Criminal CodeGovernment Orders

10:35 a.m.

Winnipeg North Manitoba

Liberal

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

Madam Speaker, I appreciate the views the member expressed in addressing this legislation.

The question I have is related to the Supreme Court of Canada. Every Supreme Court judge, and it was unanimous, indicated that Canada needed to change the law. There is a void that was created back in February. The Supreme Court gave us a legal mandate of one year. There was an extension granted. There is no doubt that if we believe in the rule of law and respect our Supreme Court that there is a requirement for us to bring forward legislation. The legislation has to pass by June 6 in order to fill that void. There is no option to not fill the void. It is our parliamentary responsibility.

Does the member believe, as many of us inside this chamber believe, that we do have a responsibility to respond to the Supreme Court of Canada, recognizing that while this might not be perfect legislation, there is that responsibility? To the best of my knowledge, I believe that this legislation meets that criteria. What does the member have to say in regard to that responsibility?

Criminal CodeGovernment Orders

10:35 a.m.

Conservative

Cathay Wagantall Conservative Yorkton—Melville, SK

Madam Speaker, I do appreciate the question, and I expected it.

I have the greatest respect for our Supreme Court. I have had the privilege of being part of an orientation, going there, and listening. It is not that I do not respect the Supreme Court and its role. However, as a parliamentarian my first responsibility is to Canadians.

I feel that the initial one-year decision by the Supreme Court was wrong. It is not enough time. Then, for the government to request six months and only be given another four months, I believe that is wrong.

We are in a situation here in Canada where we cannot get this wrong. Changing things as we go is very difficult, as my friend on this side of the House said last night. We need to do it right.

My first responsibility is to Canadians. Our first responsibility is to do what is right, regardless of the situation we are facing under pressure. I am not a lawyer. I understand the Charter of Rights and Freedoms has a notwithstanding clause that should never be abused, but perhaps in this situation that is what we should be looking at.

Criminal CodeGovernment Orders

10:40 a.m.

NDP

Kennedy Stewart NDP Burnaby South, BC

Madam Speaker, I listen with great interest to the debate on this very important issue.

However, there seems to be some confusion as to what we have been asked to do by the Supreme Court. This is not an optional measure that we are taking. The government has no option to put this bill in. It has been ordered by the court, and that is how our constitution works.

I am hearing a rather extraordinary request from the member, which is for the government to invoke the notwithstanding clause. I am not sure that would actually work in this instance. I am wondering if the member would care to elaborate on that.

Criminal CodeGovernment Orders

10:40 a.m.

Conservative

Cathay Wagantall Conservative Yorkton—Melville, SK

Madam Speaker, I am not a lawyer. We all know that. I am speaking from my heart, and I am speaking for Canadians across this country who are very concerned about the responsibilities that we have in coming to a decision on this. Ultimately, I feel our responsibility, first of all, is to Canadians. I understand that it is difficult situation that I am putting forward.

I guess I am a politician, because I went through the process and I am standing here today. However, I have to say that at this point in my life it is not about a career, and it has nothing to do with being seen to do what certain people in the House feel we should do. It is to respond to what I believe is right in this circumstance in Canada.

We have seen where this is severely abused in other countries. We have already heard from our own committee and from people across the House that they want more. The Carter family is not happy. The situation is extremely complex, and I do not believe we should be rushed into a decision.

Criminal CodeGovernment Orders

10:40 a.m.

Liberal

Vance Badawey Liberal Niagara Centre, ON

Madam Speaker, I am pleased to speak in support of Bill C-14, which would address medical assistance in dying.

The government has listened very carefully to Canadians and reflected upon the invaluable contributions of the special joint committee of members of the House of Commons, senators, the external panel, the provincial-territorial expert advisory group, and many others throughout our nation.

The bill appropriately recognizes the autonomy of Canadians to choose medical assistance in dying, while also protecting vulnerable persons and respecting the Carter decision of the Supreme Court of Canada.

My remarks will focus upon the eligibility criteria and procedural safeguards, which together represent the heart of the bill.

As the Minister of Justice has stated, the bill is aimed at addressing the issues raised by the Carter decision. The government has committed to collecting and analyzing evidence regarding how medical assistance in dying is working in practice and considering the findings of independent studies into additional issues that were not addressed in the Carter decision, which will be launched after the bill is passed.

Given the fundamental societal and medical issues that medical assistance in dying raises for our country, a cautious approach is in fact warranted. The stakes are just too high.

The bill contains five key eligibility criteria.

First, the bill would also require that the person requesting medical assistance in dying be at least 18 years of age and be capable of making decisions with respect to their health.

Several witnesses before the special joint committee, including the Canadian Paediatric Society, noted that medical assistance in dying raised unique considerations when it came to young people. Assessing a minor's capacity to decide to seek medical assistance in dying is difficult when the stakes are so high and the decision is irreversible.

Importantly, the committee also heard that there was in fact no Canadian pediatric data regarding requests for medical assistance in dying from young people or whether pediatricians would be willing to participate in this procedure. Prudence and common sense support further study of this very difficult issue.

With respect to capacity, this requirement means people must be able to confirm their choice at the time the medical assistance in dying is in fact provided. Therefore, the bill would not permit what are commonly called “advance requests”.

Permitting medical assistance in dying to be administered to a patient who is unable to express his or her wishes increases the risks of error and abuse. People who cannot express their wishes may want to continue living, even though they made a request at an earlier point in time.

Simply put, an advance request takes away the right of people to change their minds when they lose capacity.

The proposed approach also recognizes that physicians and health professionals frequently struggle with interpreting and applying other evidence directives in general. Advance requests for medical assistance in dying would be even more complicated to administer. Clearly, there is a need for further study and evidence concerning advance requests.

The bill also contains eligibility criteria that people make a voluntary request for medical assistance in dying and that they do so with the benefit of fully informed consent.

These requirements are common sense.

Medical assistance in dying must not be an alternative in situations where patients might prefer a different treatment, but are not aware of it or they do not know their diagnosis or its likely trajectory. Nor must it be the product of external pressure or the person's believe that he or she is a burden or unwanted.

Next, the bill would require that the person be suffering from a grievous and irremediable medical condition. This is defined term that has several characteristics, including the condition is serious and incurable; the person is in an advanced state of irreversible decline in capability; the condition is causing the person enduring suffering; and the person's natural death has become reasonably foreseeable in all of his or her medical circumstances, without requiring a specific prognosis.

The bill intends to permit medical assistance in dying as a choice for Canadians whose lives are on a path toward their end. As the Supreme Court suggested in various places in Carter, medical assistance in dying is similar in nature to forms of end-of-life care, such as palliative sedation, or the withdrawal of life-saving treatment. This definition is intended to allow for flexibility for physicians and nurse practitioners to consider all of the person's medical circumstance.

Bill C-14 is clear that no specific prognosis of time remaining is required. Moreover, a person could qualify based on the cumulative effect of multiple conditions or medical circumstances that individually may not be fatal, but when taken together make the person's death reasonably foreseeable. For example, people in medical circumstances similar to those experienced by Kay Carter, Gloria Taylor, Sue Rodriguez, as well the people who have obtained individual constitutional exemptions across Canada since the Supreme Court's ruling this past January, would all be eligible under this bill.

However, medical assistance in dying is not a solution to all forms of medical suffering. Such an approach would raise unacceptable risks, particularly for vulnerable people throughout our society. Take the example of someone who is exclusively suffering from a physical or mental disability, but who is otherwise in good health and whose natural death is still many years away. Making medical assistance in dying available to people in these circumstances risks reinforcing negative stereotypes of the lives lived by Canadians with disabilities, and could suggest that death is an acceptable alternative to any level of medical suffering or disability. This risks undermining our efforts to combat suicide, a pressing public health problem that affects not only those who die by suicide, but also their families, friends, and overall communities.

Next, to ensure that Canadians can have confidence that medical assistance in dying is administered appropriately, the bill also contains the procedural safeguards generally in line with those recommended by the special joint committee. These measures would ensure that requests for medical assistance in dying would be made in writing, witnessed by two independent persons, and that there would be a 15-day wait period to guard against people making a decision too quickly, which cannot be reversed. In respect of the waiting period, there would be flexibility for situations where a person's death or loss of capacity was imminent.

Most important, the eligibility of the person would have to be assessed and confirmed by two physicians or nurse practitioners who are independent of each other. The person would also have the right to change his or her mind about receiving medical assistance in dying, including just before the procedure would be administered. These safeguards will be effective at protecting Canadians but will not be so burdensome that they will impede access.

Finally, the bill would require that the person be eligible for health services funded by a government in Canada. This requirement exists to ensure that Canada does not become a destination for people from around the world who visit the country solely for this purpose by obtaining medical assistance in dying. However, recognizing that Canadians often move from one province to another or sometimes live abroad for significant periods, the bill includes an exception to this requirement to ensure these people would not be excluded solely because they are subject to a waiting period or residency requirement for public health care.

Medical assistance in dying is one of the most challenging and complex social and legal issues of our time, particularly given our society's aging population. However, the government has embraced this challenge and has listened carefully to the diverse perspectives of Canadians.

The bill before Parliament today was crafted with both compassion and clear thinking, and represents thoughtful and principled legislation. It promises the autonomy of Canadians to choose medical assistance in dying, protects vulnerable persons, and respects the Supreme Court's decision.

I call on members of the House to support this bill.