Debates of June 16th, 2016

An Act to Amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

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

Madam Speaker, I remember serving on the committee together. I agree we had very respectful although diametrically opposite points of view, but there was a large degree of respect.

As it relates to choice, it comes back again to the fact that no man is an island. When I have the right to ask for someone to help me to assisted death, it automatically implies someone else has been asked to participate in that. It is not a matter of just individual choice. That is why I have been relentlessly calling for better protections for health care workers and health care professionals who have been professionally trained and have no interest.

I have a letter from a palliative care physician, who indicates, “In addition, all palliative care providers are dually trained. We have clearly told the Canadian Medical Association and others that we will quit palliative care and do other jobs if we are forced to participate”. That is why I have been relentless on this. We cannot simply say this is a choice of mind. It is a choice that will impact another person who will be implicated in either actually carrying out the physician-assisted suicide, or referring to someone who will.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I am pleased to speak to the NDP amendment, as well as to the underlying issues raised by Bill C-14, and to address some outstanding issues.

The first thing I want to do is pick up on a question that my colleague from the NDP just asked with respect to choice. Many of the arguments in favour of this legislation have been framed around this idea of choice. However, at the same time we have to acknowledge that this bill is designed to impose significant limitations on choice as well. It does not legalize suicide in every case. Clearly, I think it suggests that there still ought to be limits on choice. That is a good thing. However, those limitations do not at all protect the vulnerable. They do not go nearly far enough. We would understand the limits of choice in that choice is shaped by values and social norms, and my colleague touched on this as well. The stigma and social acceptability around something shapes the kinds of choices that are made.

In light of the Supreme Court decision and the fact that we have to respond to it, I am very concerned, and I think many of my colleagues at least on this side of the House but perhaps in other corners of the House are concerned, that suicide remains a socially unacceptable choice, and that maybe it should be allowed in certain narrow circumstances as required, but that we do not allow ourselves to shift in a direction where we remove the fundamental stigma around taking human life, and that we maintain a fundamental respect for the intrinsic value and dignity of all human life. It is my belief that going down that road only a little bit is very difficult and perhaps even impossible. In the debate around this issue, we have already seen that, as soon as the can of worms is opened a little bit, there is a major push for expansion to all kinds of other different situations.

The language used, and the language that some members and the NDP amendment want to limit this to, is “grievous and irremediable”. It seems to me that people who take their life do so because they consider themselves to be facing grievous and irremediable suffering. Clearly, there is no one who takes his or her life who does not think that. Therefore, it is not at all a simple matter, as some members have suggested, to clearly demarcate suicide; and then, on the other hand, what is covered by this issue? Choice always has limits. It must have limits, especially when choices may impact the broader social architecture of choice under which other people operate. I think that is an important point that is underlined here, that we need to try, as much as possible, to preserve that underlying concept of the value of human life. I do not think that Bill C-14 has nearly the safeguards to do that. What we could have had, and what we should have at the very least, is some kind of clear legal criteria.

It has been interesting in the discussion today that we have the minister really highlighting the importance of the reasonably foreseeable criterion. I do not support the NDP amendment. All things being equal, I would still like “reasonably foreseeable” to remain in the bill, although I agree with the NDP that it is not at all clear what that means. Then the minister talks about the importance of this criterion and how the entire bill, the system of safeguards, was developed with that criterion in mind. She said that, clearly, if we did not have that aspect in the criteria, we would need additional safeguards. Therefore, she is putting a very large amount of weight on those two undefined words. She said that the Liberals would not want “reasonably foreseeable” to apply to a young person who had some kind of an accident and became permanently disabled. They would not want “reasonably foreseeable” to apply to somebody with just a mental health challenge. However, without meaning to those words, without some kind of clarity, it is not at all clear that those cases that the minister has identified are even excluded by this legislation. Therefore, in a sense, she defeats her own argument by saying that this legislation has limited safeguards because of the narrowing of the criteria, such as only a 10-day waiting period, but given that there was no meaningful, well-defined, narrowing of the criteria, then she acknowledges effectively that the safeguards in this bill are inadequate.

If this legislation were written with a tighter narrowing of criteria in mind, then perhaps we should have actually had some definition of what constituted the new criteria. We should have had some kind of definition of what this means. Of course, Conservatives proposed an amendment to add the word “imminent”. We can say that death is reasonably foreseeable for all of us, but death is not imminent for all of us. That would have at least provided some metric for establishing a distinction between some cases and other cases. The lack of criteria is a huge problem.

It is important, in recognizing the absence of clear criteria, that we again investigate putting review criteria in place. We have seen what the provinces have already done. The reason I say we are not in a legal vacuum is that there is no federal legislation but there are provincial rules in place, so we are not in a legal vacuum, as such, strictly speaking. There are policies and procedures in place at the provincial level. The provinces have introduced many very good safeguards that are not in this federal legislation, and it is important to say that those safeguards, in many cases, would not apply after the federal legislation passes.

Provincial guidelines, in most cases that I have seen, refer to the involvement of the attending physician. They do not just say any two physicians. They say there is some role for an attending physician and a consulting physician, implying that the person involved in adjudicating the case should be, in some ways, involved in the care of the patient and not be some doctor somewhere else who has agreed to sign all the forms for almost anyone. The involvement of the attending physician is important. It could have been included in the federal legislation, but if the federal legislation passes saying any two doctors, then the requirement for an attending physician being involved would no longer apply, because it would be prescribed a certain way in the Criminal Code.

I would encourage the government to take the experience and wisdom of the provinces seriously on this, recognizing that there are no effective legal criteria up front, there are only undefined legal criteria, and we should add in some of the more effective review mechanisms to ensure that, however ambiguous the criteria are, the legal criteria are being met, in fact, such as they are.

I have advocated for the Manitoba model, or some element of it, to be incorporated into the federal model, which involves government lawyers looking at each case. I asked my friend from Victoria about this, and he said that could pose an unnecessary barrier, such as if there are no lawyers available. The model that the Government of Manitoba has put in place includes government lawyers available to review each case. It is not as if one has to go out and find someone, and it is not a process of needing to make an application to the court, although there are, frankly, plenty of cases in the world where someone might need to make an urgent application to a court and there are provisions to allow that to happen.

Therefore, it is not at all true that this is sort of an impossibly onerous barrier, but the Government of Manitoba has done something much less than requiring judicial review. It has simply put in place a system where there is advanced legal review by government lawyers. Recognizing the value of that model, that review process, the government should think about incorporating that into federal legislation or, at the very least, ensure it is not proceeding in a way that interferes with or overturns that provincial set-up.

In conclusion, I want to speak briefly to the issue of protecting the vulnerable. There has been some discussion here about what constitutes vulnerability and who is vulnerable. We can understand “vulnerable” as referring to people who probably, in ideal circumstances, would not choose death, but are in some way in not ideal circumstances, which limits them and propels them toward a choice they would not otherwise make. This can happen often, whether it is a person who does not have perspective because of his or her situation, or whether someone is sort of the victim of suicide contagion and is responding to other things and situations happening in his or her life. It could be someone who is influenced more by social than physical circumstances. We need to be attentive to these things, and that speaks to the importance of robust safeguards.

I hope we can, as a House, still at this last stage, try to bring in some meaningful definitions and safeguards that would protect the vulnerable and protect Canadian society.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to thank my colleague fromSherwood Park—Fort Saskatchewan for his third intervention today on this issue. I appreciate his passion and commitment to the cause he is trying to defend.

The member brought a number of amendments to committee, I think probably in the dozens. Many of them were not even supported by members of his own party at committee, but they were all fairly debated and fairly defeated.

I want to get back to the premise at this point of needing a law in place. I disagree with the hon. member that the provincial regulatory bodies are sufficient. I think we need national standards in place.

Does the hon. member not agree that, if it is the will of the vast majority of this House to get a law in place, we should do our best and utmost to get a law in place today?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I thank the member for his good work as a chair. He might remember that I proposed a mere one dozen amendments, or thereabouts, and I actually got three amendments passed. They were not substantive enough to address the major problems that remain in the bill, but I figure that is not a bad record for a member of the opposition in a majority Parliament.

With respect to the issue of national standards, I would be happy to see national standards that would provide meaningful safeguards. My concern with the legislation is that we have some of this ambiguity, the lack of safeguards, which I have discussed in my small number of interventions on this subject.

Also, the effect of the federal legislation would be that it undermines the existing safeguards that are at the provincial level. It would have the effect of changing the way that those operate. Therefore, the requirement that an attending physician be involved under provincial criteria would be negatively affected by the federal criteria, and that is pretty clear in the guidelines that have been put forward. They are put forward as interim guidelines, because the provinces do not want to be in the situation of legislative conflict.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I would like to thank my colleague for his third speech today. I had the opportunity to listen to him at the special joint committee, which helped me better understand his position.

I think that no human being makes light of asking for medical assistance in dying. It is impossible to take this issue lightly.

Organizations representing the disabled appeared before the committee and told us about the importance of respecting the rights of the disabled because the Supreme Court talked precisely about rights and about recognizing them as persons.

I am concerned when I hear my colleague say that we must not give people too many choices. Even a vulnerable person, a person who is suffering, can make a decision.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I certainly would not have it suggested that I accuse anyone of taking this issue lightly, either people in this place or the people who are involved in health care. However, I think it is pretty clear that different interpretations of these criteria will exist.

I have raised a concern about doctor shopping, that people could go from physician to physician under the framework established by this law to find someone with a more liberal interpretation of the criteria. In effect, we would end up with a race to the bottom, with people getting adjudication by doctors with the most liberal criteria. That is not to suggest that they do not take it seriously but that, if the criteria are to be meaningful, then there has to be some consistency in the adjudication.

I am sure the member would agree that in certain cases, in certain situations, there have to be limits on choice. We might disagree on exactly where those limits are, but I think all members of the House agree that there are certain cases where suicide should not be allowed and that we should not let just anyone and everyone who wishes to take their life do so. We have to then come up with a metric for adjudicating that on the basis of perhaps vulnerability or perhaps how they are affected by other social factors that make that choice a meaningful expression of their autonomy or not.

These are the things that I think we have to take into consideration regardless of our broader perspective.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, it is a privilege for me to rise again in the House to speak about the sensitive and complex issue of medical assistance in dying.

This morning, I had the honour of seconding the motion of my colleague, the member for Victoria. I would like to reiterate how much I admire and respect the commitment and sense of responsibility he has shown throughout the process that has brought us here today.

I have had the opportunity to learn from his great expertise in constitutional law on many different occasions. I am a new member who was elected on October 19, 2015. The Special Joint Committee on Physician-Assisted Dying was the very first parliamentary committee that I have ever been a member of. It was a great privilege for me because all the members of the House of Commons and the senators who worked on that committee did so in a spirit of co-operation in order to achieve the best possible outcome. We did not always agree, but we had a lot of respect for one another and we listened to what everyone had to say. We wanted to ensure that we made the best possible decisions and recommendations for the benefit of all Canadians, while respecting their rights. The 21 recommendations that we did make reflect that desire. One of our main goals throughout our discussions was to ensure that no one was discriminated against.

Naturally, Bill C-14 could not include all 21 recommendations. As I said after our report was released, I think it will continue to be useful for years to come.

My colleague from Victoria and I felt it was important to augment the committee's work with a supplementary opinion. The one thing all of the witnesses agreed on is that medical assistance in dying is linked to palliative care.

We also felt it was important to write a supplementary opinion to connect this issue to all other social determinants. It is important to say that we all have equal rights. However, because of certain social constraints, we must ensure that social determinants are taken into account in implementing medical assistance in dying.

As a member of the committee, I was astounded at the level of expertise we have in Canada on this issue. We heard from more than 60 witnesses, and we read thousands of pages before drafting our report and recommendations. I have a great deal of admiration for many of the witnesses who appeared before us because they put a lot of careful thought into this sensitive issue.

Our thinking on medical assistance in dying has changed in this country. The Supreme Court's Carter decision is proof of that. The witnesses talked to us about the change that has taken place in society. Looking back at the Rodriguez ruling from 20 years ago, it is clear that our society's thinking on end of life has changed.

I believe that our report and recommendations attest to that, and that is why it is so important to me that the bill we pass in the House reflect our constituents' thoughts on this matter. The witnesses, particularly groups representing people with disabilities, put a lot of careful thought into this matter and came to share their ideas with us.

I found it particularly hard when some of these groups told us that a few of their members had had friends or loved ones commit suicide prematurely. We currently have no measures to give these people hope that they will be able to freely choose at which point they will make a request for medical assistance in dying. That concern stuck with me.

I was also struck by the testimony from doctors who came to tell us that the Carter decision, which was handed down on February 6, 2015, changed their profession drastically. These doctors, like the ones I met in my riding, told us that throughout their training and their careers, they have been taught to heal and, failing that, to extend life. Now, they are being told that, according to what the public wants, what the law allows, and what their rights allow, patients in our country will be able to submit a request for medical assistance in dying.

I listened carefully to a number of speeches since we started having this discussion. During my many meetings in my riding of Saint-Hyacinthe—Bagot, I pointed out that it is not up to us, in the House, to decide whether medical assistance in dying should be available or not. The Supreme Court has already ruled on that issue. It is up to us to amend the Criminal Code.

I am from Quebec. The people of Quebec have had the Act respecting end-of-life care since December 2015. As many people have said in the House, that act was the result of six years of work to reach a broad consensus. Of course, in order to reach that broad consensus in Quebec, the legislation still had to comply with the federal Criminal Code. The province could only go so far within its areas of jurisdiction. Now we can pass legislation that allows us to go even further.

The consensus that emerged in Quebec and that was confirmed in my discussions with my constituents is that we now recognize that we have reached a time in our civilization when, as citizens, we want to be able to choose. What the Supreme Court told us is that the Canadian Charter of Rights and Freedoms gives us the freedom to request medical assistance in dying.

In order to deepen my reflections throughout our deliberations in the Special Joint Committee on Physician-Assisted Dying, I felt duty-bound to seek out people and groups in my riding, Saint-Hyacinthe—Bagot, who are dealing with this situation every day and meet with people who are sick or dying. This includes stakeholders and volunteers with a community organization called Les Amis du crépuscule, which provides assistance to people receiving palliative care and later to their grieving families. There are user committees for health care institutions, as well as the Hôtel-Dieu-de-Saint-Hyacinthe hospital foundation. That institution is one of the largest long-term care facilities in Quebec. Hundreds of people spend their last days on earth at the Hôtel-Dieu-de-Saint-Hyacinthe. I think it is around 500 people. That hospital has hundreds of beds, but only 12 palliative care beds.

That is why it has been important from the start of this debate on medical assistance in dying to talk about developing and implementing a real national palliative care strategy. For medical assistance in dying to be a real choice, palliative care also has to be offered as a choice. Unfortunately, many people have limited access to palliative care.

In Saint-Hyacinthe—Bagot, people have access to Maison Victor-Gadbois, a home for end-of-life care for those with cancer. This home receives 800 applications a year, but can house only 200 people.

Doctors have told us that we have developed a health care system based on hospitals and healing. When I met with Monsignor Lapierre, bishop of the Saint-Hyacinthe diocese, to talk about this issue, he made a comment that was full of wisdom. He told me that we should be just as concerned about aggressive treatment as we are about medical assistance in dying. He is sometimes called to the bedside of people who tell him they have had enough.

We must vote on this issue of medical assistance in dying here in the House with a sense of the responsibility we have to represent our constituents who are living with a serious and irremediable illness and intolerable pain.

Every time I rise in the House to speak to this issue, and during each meeting of the joint committee and the Standing Committee on Justice and Human Rights, which studied this bill, I think about the people who are suffering. They are the ones who are at the heart of our discussion on Bill C-14. There are people who are suffering now, and they have high expectations for the bill we are going to pass. When the Supreme Court rendered its decision in Carter, people who were suffering had hope that their right to request medical assistance in dying would be respected.

The amendments in the motion by my colleague from Victoria say that we must not disappoint these people who are suffering and awaiting our decision. They hope that we will allow them to make this request for medical assistance in dying soon and that their rights will be respected.

These people who are suffering need not go to court. I was touched by the testimony given by members of the Carter family, who spent many years before the courts with their mother. When Bill C-14 was introduced, they came to tell us that the bill would not even give their mother the right to request medical assistance in dying. I cannot rise in the House and vote in favour of this bill, knowing that I am leaving people who are suffering to their own devices because they are not in the right class to be eligible for medical assistance in dying.

This week, the Minister of Health told us that we need to think not only about the rights of Canadians, but also about the work of doctors. Since I began thinking about this issue, I have realized how much respect I have for all health care professionals. I also have a lot of faith in their judgment.

The doctors who testified in committee said that, while requests for medical assistance in dying are a new part of their reality, they have been dealing with difficult requests from patients that require them to use their judgment every day since they became doctors.

The difference since the Supreme Court ruling in Carter is that now they must deal with requests for medical assistance in dying. These decisions will be difficult for some. Fortunately, the bill gives them the right to conscientiously object and tell the patient that they are not comfortable complying with their request. We think it is important for the health care system to ensure that patients will not have to find a new doctor in the yellow pages. They must have support in order to exercise their right to ask for medical assistance in dying.

We also believe that sufficient safeguards have been put in place. I was really moved by the representatives of organizations for the disabled who asked us not to be paternalistic or treat the disabled like children. The fact that they have an incurable disease or are living with a degenerative disease or suffering a great deal is no reason to treat them like children. They are autonomous and can provide informed consent.

The Supreme Court talked about suffering that an individual deems intolerable. Nobody can judge another person's suffering. We all react differently to illness. That respect for individuality must permeate the medical assistance in dying law we implement. We must ensure that each individual, each citizen of this country, has the freedom to make that choice if the situation arises.

Nobody in this country wants to be in the position of having to make this request. Nobody wants to face the choice of whether to request medical assistance in dying. Nobody wants to support a loved one in making a choice about requesting medical assistance in dying. Nevertheless, we all hope that, when that day comes, every person will have all the resources they need to give free, informed consent. We hope that every person will feel their rights are being respected and will not be told that, unfortunately, they belong to a small class of people who are not eligible because it is felt that their death is not reasonably foreseeable.

Many, including the Barreau du Québec, the Collège des médecins du Québec, and Quebec's health minister, came and told us that “reasonably foreseeable natural death” does not mean anything and is impractical. In my opinion, we are putting doctors in a position where they cannot reasonably use the flexibility we are trying to give them in a fair and equitable manner because this criterion has no clear meaning for a doctor.

We must ensure that the legislation we pass is consistent with the Supreme Court's decision in Carter and with the Canadian Charter of Rights and Freedoms. We must ensure that once this legislation is enacted people who are suffering will not be required to ask a lawyer to go before the courts to uphold their right to seek medical assistance in dying. At the Special Joint Committee on Physician-Assisted Dying, we heard that the provinces are ready to continue their work to enact provincial legislation. Quebec's health minister said that he was pleasantly surprised at the work of his colleagues from the other provinces.

Today we must pass legislation that is consistent with the Supreme Court's decision in Carter, that is consistent with the Canadian Charter of Rights and Freedoms, and that allows every Canadian to request medical assistance in dying.

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

Madam Speaker, I have heard, not only during this particular debate, whether it is at second or third reading stage, a great of expression with respect to the reasonably foreseeable issue in the definition.

I am wondering if the member would acknowledge that if we were to check with the legal community and the medical profession that there are differing opinions on this issue.

I really and truly believe that this legal framework we are establishing will in fact be constitutional, and because we have one or two opinions to the contrary does not necessarily mean that it is not. I wonder if she could pick up on the point that there will always be differing opinions.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I understand that when the Canadian Medical Association does a poll, doctors might say that they need to work through a process before they are fully prepared. Palliative care doctors even told us that there is not enough training in palliative care. Few physicians are trained to support people at the end of life. Clearly, physicians have some challenges ahead of them. The various professional associations from different provinces, for they are the ones directly involved, not the Canadian Medical Association, told us that they have given their members very clear directives and that they are there and ready to support their members to ensure they can get prepared and are able to meet their patients' requests for medical assistance in dying.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, we hear a lot from the NDP about the importance of palliative care, so I want to ask her a question about how palliative care fits into this.

I moved an amendment, supported by our caucus, to require that patients receive information about palliative care options. That would be one of those fairly minimal safeguards that I think could have improved the bill. However, she and her caucus voted against the amendment that would have simply said that people need to receive information about palliative care options before receiving euthanasia or assisted suicide.

I want to ask why she voted against that amendment, and why New Democrats would not support these simple safeguards that do not create a real burden but simply ensure that patients have access to information about other options.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I disagree on the point that it does not add anything to the burden. Every time we add excessive safeguards and put anything else between a request from a patient and a response to that request, we impede the process unnecessarily.

We need to bear in mind that we are talking about people who are experiencing suffering that they deem intolerable, day after day after day, every minute of their lives. We must not add any obstacles. We must not say that the patient should have access to this or the patient should be able to get more information. No, the process needs to be simple and clear to anyone who is suffering.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I thank my colleague from Saint-Hyacinthe—Bagot for her informative speech. I always like listening to what she has to say.

She mentioned that the medical profession, by definition, has had to change because it is paternalistic. Progress has been made in the practice of medicine by various disciplines, such as bioethics, which has been working to counter paternalism by placing more emphasis on the patient's right to self-determination.

Right now, many doctors are having a hard time understanding that the practice of medicine will have to continue to progress and change. Medicine is not just about curing diseases; it also about caring for people. End-of-life care falls under provincial jurisdiction.

Does the member agree with me that doctors will have to be trained so that they are properly prepared not only to cure diseases, since some diseases cannot be cured, but also to care for patients, including those who are at the end of their lives or who have—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The hon. member for Saint-Hyacinthe—Bagot.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I would like to thank my colleague for his question. I appreciated his expertise in bioethics when we were working on this issue.

Doctors' associations testified in committee that most of their members were prepared to adapt to changes in our health care system. However, it is clear that the government needs to give the provinces the funding necessary to make these changes in our society.

In the past, the federal government provided up to 50% of funding for provincial health care. However, in recent years, it has been providing only 17% or 19%. It needs to contribute a minimum of 25%. The decision that we are going to make on medical assistance in dying must go hand in hand with assistance and funding for the provinces so that doctors are properly trained to respond to these requests.

[François Choquette, NDP, Drummond, QC]

Madam Speaker, I would like to congratulate my hon. colleague from Saint-Hyacinthe—Bagot for her excellent speech and her contribution to this debate. Together with my colleague from Victoria, she has worked very hard on the issue of medical assistance in dying. I tip my hat to them because it is not an easy subject.

My sister works at Hôtel-Dieu-de-Saint-Hyacinthe and so I am somewhat familiar with this subject. She tells me about all kinds of things that happen there. It is not always easy. It takes a lot of energy. At present, there is a shortage of resources for and a lack of commitment to palliative care. In my riding, people are working very hard on the issue.

Can my colleague explain why the government's recent budget did not include the money needed to invest in palliative care?

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, that was the big disappointment with the budget. Since tabling its budget, the government has repeatedly promised to invest $3 billion in palliative home care, and people believe that it is in the budget.

In my riding, people told me that the government had finally kept its promise, which is not the case because it is not in the budget. The government continues to make that promise, but we do not know when it will materialize.

My colleague spoke about the Hôtel-Dieu. I met a nurse who has worked in palliative care for 20 years. She said that some doctors do not have any palliative care training, and in order to alleviate patients' suffering they would prescribe two aspirins or something like that. She knew from experience that that was not enough to relieve the pain.

Therefore, we need a framework and support to provide appropriate palliative care across the country.

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

Madam Speaker, perhaps the member could provide further comment on how important it is that the different stakeholders, in particular the federal government, work with the different provincial governments and indigenous people to ensure we have the type of palliative care that Canadians want. I would like to provide her with the opportunity to comment on the issue of collaboration with the provinces.

[Brigitte Sansoucy, NDP, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I was a municipal councillor for several years and I worked as a public servant for the Government of Quebec, so I have a huge amount of respect for the jurisdictions of all levels of government.

Palliative care does indeed fall under provincial jurisdiction. Quebec worked very hard on this when it passed a law on end-of-life care. At the Special Joint Committee on Physician-Assisted Dying, we considered this issue and heard from a panel of provincial and territorial experts who had studied it.

I think that the provinces are ready and that the territories and indigenous communities are on board.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I will share my time with my hon. colleague from Winnipeg North.

I rise today in the House to speak to Bill C-14, for the last time, I hope.

Although it was sometimes quite heated, I think that the debate on Bill C-14 brought out the best in us as parliamentarians. All parliamentarians showed a great deal of respect, even though we all have different perspectives on a very sensitive and emotional topic.

Today, I will talk about the amendments that were proposed by the other chamber. I support the motion by the Minister of Justice to accept some amendments and reject others.

The palliative care amendment that was brought in by the Senate is a good amendment. We had a lot of discussion at the Standing Committee on Justice and Human Rights and here in the House on the balance between access to medically assisted dying and the importance of ensuring quality palliative care. The fact that the Senate has once again reinforced the importance of ensuring that information be provided on palliative care before someone has access to medical assistance in dying is something that we should accept. I am pleased that we are going to accept that as amended by the Minister of Justice.

I am also pleased that the Minister of Health will be required to set out guidelines for death certificates within one year. We made amendments at the Standing Committee on Justice and Human Rights to require the Minister of Health to work with her provincial and territorial counterparts to set standards to include coroners. This amendment falls well in line with what the House has already accepted.

It is entirely legitimate for the Senate to ask for a deadline with respect to the studies that will be done on advance directives, mature minors, and psychological illnesses, and to require them to be delivered back to Parliament within two years from the time the studies begin. We in committee amended this to say “must commence within six months”, which is also a reasonable requirement.

What is also eminently reasonable and strongly follows the will of the House of Commons is the minister rejecting the amendment to remove the criteria of death being “reasonably foreseeable”. Removing that requirement entirely changes the bill from applying to someone who is near the end of his or her natural life to encompassing people who may have 30 or 40 years left to live. It may encompass people who have purely psychological illnesses, which was not the intention of the bill, because we have specifically stated that we are doing a study about people who have psychological illnesses.

However, if we look at the definition of “grievous and irremediable” and take out subsection (d) on reasonable foreseeability, then we fall into a situation where someone who has a psychological illness may meet the criteria of subsections (a), (b) and (c), thus completely changing the position of the bill on whether people with purely psychological illnesses can have access to medically assisted dying.

I want to emphasize from a public policy perspective that this legislation took a prudent approach. We can argue back and forth about what medical doctors and lawyers and law professors have said. I sat in committee and listened to well over 40 witnesses. I also had the pleasure of periodically glimpsing in on the Senate Standing Committee on Legal and Constitutional Affairs and listening to its witnesses.

Doctors, lawyers, professors, distinguished people came down on all sides of this issue. There are those who say that the bill is not Carter-compliant or charter-compliant and there are just as many, if not more, who say that the law is Carter-compliant and charter-compliant. In my view, it is the role of Parliament to determine what we believe to be charter-compliant. It is the role of Parliament to determine the best public policy within a charter-compliant law.

Medically assisted dying to me is meant to help people who are suffering intolerably but have an illness that will extinguish their life at some future date.

The court, in Carter, talked about Gloria Taylor and people like Gloria Taylor. Gloria Taylor had ALS. Gloria Taylor was undisputedly going to die from the illness she had.

I believe that ensuring that death is reasonably foreseeable falls entirely in line with public policy guidelines that we expect. Doctors and nurses, many of them, came before us and said that they did not go to school for many years to end people's lives. They went to school to try to help people who were suffering, to try to prolong life as long as possible within the framework that we currently have in the profession. They did not go there to be told that someone who comes to them and who may have many years left to live, and who has an illness that we may find a cure for in four or five years, should have their life extinguished.

As such, I do believe the minister is making the right decision to reject that Senate amendment. I also believe the government carefully researched what was being done in other jurisdictions. There are only nine jurisdictions in the entire world that have legally regulated medical assistance in dying. In all but three of them, there is a requirement that the person's life be near its end.

Whether it is Colombia, or the four United States' states that have these rules, or whether it is Quebec, which adopted its own end-of-life framework, which I understand is different and was pre-Carter, all of them require that a patient be dying, at the very longest, within the next six months, under reasonable medical certainty.

Only in the Netherlands, Belgium, and Luxembourg do we allow people to have their lives taken by medically assisted dying if their natural life is not close to an end. What kinds of situations have we seen in those jurisdictions? We have seen people who I believe many of us in this House would believe should not have access to medically assisted dying being given medically assisted dying.

We saw twins in their 40s, who were blind and starting to go deaf, for example, but had no other conditions that would end their life. Those people needed help, real help, psychological help, help to live their lives, not being told, yes, they should go die together now. People who were purely psychologically ill, who could not get over traumas related to sexual assault. These may be incredibly traumatic psychologically, but there are ways of helping those people that do not involve medically assisted dying.

I do not think Canadians, when we are talking about all the opinion polls that are being cited, where there is support of over 70% for medically assisted death, are contemplating those situations. They are contemplating situations where someone is nearing the end of their natural life and is in intolerable pain.

For me, if we removed reasonable foreseeability, we would be asking the medical profession in Canada, the nursing profession in Canada, other medical practitioners in Canada to be participating in medically assisted death beyond where they decided to do, and even more importantly, we would be doing so without the safeguards that would have been put in the bill had we intended that that class of people be covered. There is no way that a 10-day waiting period suffices when somebody could have 40 years left to live.

In conclusion, I want to say that I support the motion from the Minister of Justice, and I will be voting in favour today.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, I thank my friend for his speech and for the work he did as chair of the justice committee. Of course we do not always agree, but I thought he was a very fair-minded and very effective chair of that committee. I want to commend him for the work he did.

Now, listening to his speech, it sounded as if he was motivating the idea of a terminal requirement within the legislation, or a requirement for imminent natural death, and yet the provisions that the government is defending, the language “reasonably foreseeable” is not at all clearly pointing us to terminal or to some kind of imminent situation.

I proposed an amendment at report stage, as he knows, that inserted the word “imminent”, and I believe he and all of his colleagues on that side of that House voted against adding that kind of clarity to the bill.

It seems to me that there is a bit of a disconnect between some of the very real issues and concerns he raises with there not being an imminent requirement, and yet the government's opposition to in any way clarifying that imminence is what reasonably foreseeable means. Without that clarification, that is not what it means.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to thank my colleague, the member for Sherwood Park—Fort Saskatchewan, for the very strong contributions he made, both in the debate in the House and at committee. I also appreciate working with him.

With respect to those comments, I think that what I am saying is that “reasonably foreseeable” means, as the minister has stated, that someone is on the path toward their natural death.

What we heard at committee was if we used the word “imminent”, it means the death is going to happen within the next month, and I do not believe that it would be the best public policy approach to take such a restricted term, nor would it necessarily be charter-compliant, in my view.

I believe that while I personally would have been comfortable having a longer time frame, such as a year, in the bill, I also understand the reasons there is not that time frame. I am comfortable with the concept of “reasonably” in assisted death knowing that means that, based on someone's overall medical condition they are on that—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Order, please.

Questions and comments.

The hon. member for Edmonton Strathcona.

[Linda Duncan, NDP, Edmonton Strathcona, AB]

Madam Speaker, I, too, would like to thank the member. I know he has been working hard, along with my colleagues, on the bill for quite some time. We would all like to have some legal clarity for Canadians.

What troubles me and troubles both of my colleagues is the result of the bill tabled by his party in now rejecting the very amendment from the other place. The exact effect will be to exclude this option to the very people who have now been allowed that option by the Supreme Court of Canada because it is their charter right. The result of the bill will be that the very people who happen to be 45 years old and are suffering from this grievous and irremediable disease will not get this assistance but somebody perhaps who is 99 will.

I fail to understand, and the member can explain to me, why they would exclude my constituents who have had to go to court for exactly those kinds of situations and would now be prohibited from getting that medical assistance.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, in my view, the Supreme Court spoke to Gloria Taylor and people in the same class as Gloria Taylor. I do not believe the Supreme Court was speaking to someone whose death was not naturally foreseeable. We disagree as to what the terms of the Carter decision are. We actually completely disagree.

As I mentioned in my speech, I do not believe that the Carter decision requires us to encompass the class of people of which the hon. member is speaking. We have defined “grievous and irremediable” as being someone whose death is naturally reasonably foreseeable within the context of their overall condition, and I believe that will be both Carter-compliant and charter-compliant.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I thank the member for Mount Royal, who is always such a gentleman. How could he be otherwise, with a name like that?

Nevertheless, I do believe he is exaggerating somewhat. He talked about Ms. Taylor, but he said very little about Kay Carter. According to the reasonably foreseeable death criterion, Kay Carter would not have had the right to medical assistance in dying unless she argued on the basis of age discrimination.

Is that what we want? Do we want a law that condones discrimination on the grounds of age or illness? Ms. Taylor had amyotrophic lateral sclerosis. It is as though this bill were designed—