Mr. Speaker, as members are aware, Bill C-14 now goes to third reading, which gives the Senate two days to consider it before the June 6 deadline.
While I acknowledge the government's expressed desire to get the bill passed before the Supreme Court's June 6 deadline, I think most people agree that this is too important a piece of legislation to rush, especially considering that in its present form it is not likely to pass constitutional muster. On this, I second NDP justice critic, the member for Victoria, when he said, “I cannot accept passing a bill that I know to be unconstitutional”.
The key flaw of Bill C-14 is the end-of-life requirement of a reasonably foreseeable natural death. This is the part that conflicts with the Supreme Court, which did not require terminality or end of life, and therefore, according to the Carter decision, infringes on the charter rights of all those who have a grievous and irremediable condition that causes them intolerable suffering but who are not dying as a result.
The Canadian and Quebec bar associations, various other legal experts, and now the Alberta Court of Appeal, has said that this requirement conflicts with the Supreme Court. Medical groups do not like it either. The body that represents every provincial medical regulator has come out against the bill as being too vague for doctors to follow.
The NDP put forward a number of amendments that would have improved the bill tremendously. Had they not been rejected, the bill would likely have had a better shot at making it through the Senate.
We suggested removing the controversial end-of-life requirement, which is almost certainly unconstitutional, and replacing it with the exact words that the Supreme Court used in its decision. However, the Liberals rejected that.
Of more than 100 amendments moved, just 16 were accepted, and they were mostly minor technical clarifications. However, the NDP did manage to secure agreement on two amendments that were introduced and adopted unanimously, and that was clarifying conscience objection rights and adding a stronger commitment to palliative care.
As criticism grows against the bill, the government increasingly falls back on the excuse of a deadline imposed on us by the Supreme Court, which is not exactly true. The court said that it would give federal and provincial governments a year to put in place more complex regulatory regimes should they choose. On June 6, an exemption is opened in two Criminal Code offences for patients and physicians acting within the guidelines that the court set out in the Carter decision.
There is not a vacuum, and to be blunt, murder will not become legal, nor will medical aid in dying return to being illegal without a federal law in place.
Over the past year, every provincial medical regulator has developed guidelines for medical aid in dying that physicians must follow. These safeguards are very close to the safeguards proposed in Bill C-14. Federal leadership is necessary to ensure that access is equitable across Canada and to prevent a patchwork, but it is not strictly necessary to ensure basic access right now. Therefore, this final push to get the bill through the House is most unfortunate, and it is not the outcome we had hoped for.
The NDP worked long days in good faith with other parties, but it is better than passing a flawed bill, defying the Supreme Court, and infringing on the charter rights of suffering Canadians, which prompted this legislative response in the first place. For us, this is not a partisan issue. We have collaborated with all parties from the start on this and will continue that constructive approach, especially when it comes to championing the causes for our health care and palliative care.
We had a chance to get this bill right, but the government does not seem interested in listening at this point. It is important here to step back and reflect on how we got to where we are now.
In February 2015, a unanimous Supreme Court ruling established the charter-protected right of competent adult Canadians experiencing enduring and intolerable suffering as a result of grievous and irremediable medical conditions, including a disease, disability, or illness, to access medical assistance in dying. In February 2015, the Supreme Court unanimously decided in Carter v. Canada that Canadians who are suffering intolerably because of a grievous and irremediable medical condition have a charter-protected right to access medical assistance in dying.
The effect of the ruling was suspended until June 6, 2016. The reports of an interprovincial task force and a federal expert panel, as well as a wide array of witness testimony, were considered by a joint special committee of Parliament, resulting in 21 recommendations on a legislative response to Carter.
We succeeded in adding major actionable recommendations on palliative care to that report. This issue of palliative care is what, for myself, goes directly to what I object to most about Bill C-14 in its current state.
Should the government rush into a bill like Bill C-14 without also having a plan to shore up and extend palliative care? The answer is, of course, most emphatically no, it should not.
As noted in the recent report by the Canadian Cancer Society, “Right to Care: Palliative care for all Canadians”, there are gaps in palliative care across the country. As my colleague mentioned in her speech, it is very heart-wrenching to know some of the stats and facts about what is actually available right now in palliative care for Canadians.
It is an epic fail for the government to be putting forward a bill while at the same time ignoring the real tangible details that we need to give us confidence as we move forward in a future with medical-assisted dying. That was so insensitive.
About 45% of cancer patients die in acute care hospitals, even though most Canadians prefer to die at home. Not only are acute care settings more costly than dedicated palliative care, they are also not equipped to provide the most appropriate care to palliative care patients and their families.
Palliative care can increase the efficient use of our public health care dollars, but increased care outside of a hospital setting can place undue financial hardship on family caregivers. Health care costs tend to increase substantially in the months and weeks before death, due to increasing frailty and dependence on health care services.
We believe that the government should take a lead in providing appropriate funding for palliative care. Improving palliative care in all settings, including outside the hospital, should result in a more efficient use of health care dollars.
However, there will be upfront costs to facilitate change. Federal, provincial, and territorial governments should work together to establish a financing plan, and create a national palliative care transition fund to ensure the changes needed to improve palliative care in Canada can take place.
When I look at the latest version of Bill C-14, it states that:
...it commits to working with provinces, territories and civil society to facilitate access to palliative and end-of-life care, care and services for individuals living with Alzheimer’s and dementia, appropriate mental health supports and services and culturally and spiritually appropriate end-of-life care for Indigenous patients.
Now, it is all well and good, but precise commitments need to be made, and this bill is quite vague.
The only other time palliative care is mentioned in the bill is:
....this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.
On the fifth year? To me, this seems to be way too far in the future. Canadians of all political persuasions and faiths, indeed, Canadians of goodwill everywhere deserve something more definite and concrete than a promise to review palliative care within five years.
This is all the more disappointing, given that the government could have addressed this issue in its recent first budget as it knew that we would soon be debating Bill C-14. However, as we know, not a single dollar was earmarked for palliative care measures. We should have fortified health care, palliative care, home care before we crafted Bill C-14. It would have alleviated our anxiety on what the future holds.
