Debates of June 16th, 2016

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

[Sean Casey, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Mr. Speaker, I thank my colleague for his passionate intervention. His participation at every stage of this debate has indeed been thoughtful. Although we do not always agree, there is no denying the comprehensive and heartfelt nature in which he addresses the debate.

I want to ask the member a question about the speech that was put forward by the Minister of Justice.

The Minister of Justice indicated that when we take out the words “reasonably foreseeable” and leave the bare words of the Carter decision, we are left in a situation, and we draw this experience from the most permissive regimes in the world, where it is possible that a soldier with PTSD, a sexual assault victim, or a young person with a spinal cord injury, under those permissive regimes and without the reasonable foreseeability language, will be able to avail themselves of medical assistance in dying.

The member talked about us bringing forward something that would make Canadians proud. Therefore, my question for him is whether he agrees with what the Minister of Justice has said, that we owe a responsibility to those individuals in the legislation that they be protected under Canadian federal law. My question is whether he agrees that this is a responsibility that we hold, and whether we will be maintaining that responsibility by defeating the motion before Parliament.

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I will start by thanking the parliamentary secretary for the nice things he said and to say right back to him that it has been a pleasure to work with him on this difficult issue. I know that all members of the House know how sensitive and difficult this topic is for all of us. I just want to acknowledge the very respectful way in which he has conducted himself throughout this process.

I do accept that responsibility to be mindful of the sexual assault victims, PTSD victims, and the like. I would say, however, that I agree with the Supreme Court that we can do that. It heard the evidence and came up with the test that is before us in the Carter case, which would be in the legislation should we insert that language in it. The safeguards, such as a reflection period, which is in the bill, would address the issue in part.

However, I have to remind the hon. member that we have as well the very intricate safeguards that each of the provincial regulatory authorities have suggested need to be in place. We cannot look at this bird with just one wing. I would agree with Dr. Douglas Grant that the reasonably foreseeable language is “too vague to be understood or applied by the medical provision”.

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

Mr. Speaker, I thank my friend for his speech. He knows that we have some substantial disagreements about this issue, but it is interesting to find myself agreeing at least with the parts of his speech where he talks about how “reasonably foreseeable” is ridiculously ambiguous. I know that he wants a more open regime and I want it to be clarified in perhaps a more restrictive direction, but for us to have a phrase in the legislation that is largely meaningless, and to act as if that is a safeguard, is clearly a problem.

I would ask the member what he thinks about the Manitoba structure in place, where government lawyers would review every case. There is no requirement of judicial review, but there is a process by which a competent legal authority, not just medical authority, is involved in looking at every case.

That seems to me to be a good model. It is one that has been put in place in Manitoba. Is that something the member would see as an improvement to the legislation?

[Murray Rankin, NDP, Victoria, BC]

Mr. Speaker, I want to acknowledge the contribution the member for Sherwood Park—Fort Saskatchewan has made throughout this process in both committees.

The idea that the Manitoba regulators have of interposing a prior judicial restraint, if you will, or the process that the member described, could constitute an effective barrier to access. Canadians accept that their doctors look after them in life, and I believe, with the safeguards that are in place to deal with conflict of interest, a reflection period, and the like, we can trust the same physicians to look after us in death.

I worry about barriers that would impose, particularly in non-urban areas, the notion of finding a lawyer and the like. In Nunavut or northern Manitoba for that matter, it is somewhat troubling. Therefore, I think that would be an effective barrier. I do not think it is required.

I think we have it right in Bill C-14. I just wish the test of eligibility would embrace all Canadians and allow those who won the victory in Carter to not have to march back to the Supreme Court in a few months to be told that.

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

Madam Speaker, I would like to begin by expressing my admiration and respect for the commitment and sense of responsibility that my colleague from Victoria has demonstrated in this complex and sensitive issue. I have benefited from his expertise in constitutional law on a number of occasions.

This week, as a way of justifying the provision on reasonably foreseeable death, the Minister of Health said that it is not just Canadians' rights that are at stake here. She said that we must also consider the challenge for doctors to carry out the requests for medical assistance in dying.

Like me, my colleague heard representatives from the medical profession when they appeared before the special joint committee or the Standing Committee on Justice and Human Rights. Naturally they said that their profession has changed dramatically since February 6, 2015. How are they dealing with these new requests?

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, let me say at the outset what an absolute pleasure it has been to get to know and to work with my colleague from Saint-Hyacinthe—Bagot. She has been an extraordinarily effective member of those committees.

The question involved reasonably foreseeable and the effect on doctors of that test, as well as on patients. Should we be concerned about the doctors and health care practitioners who will be called upon to implement this bill?

It troubles me greatly when I hear the head of the regulatory body for all doctors say that this is unworkable. For the life of me, I cannot understand how the government can bull ahead and no doubt get this bill passed in the face of that opposition. We have a top constitutional lawyer saying that it is not consistent. We have the head of the regulatory body for all doctors saying that they do not know what it means. Now we have before us the chance to fix it by accepting the amendment before us. I urge the House to do so.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I want to thank the member for Victoria for his passionate speech and his incredibly dedicated work on this file. It has been an honour to work with him.

I want to say that the Canadian Medical Association differs with what he just said. There have been many doctors' associations testifying before our committee that disagree.

However, I have a different question with respect to the waiting period. The member mentioned, and I appreciate, that in the other place they removed reasonable foreseeability. Then we run into this debate about people who have a traumatic injury, become a paraplegic, and suddenly have an emotional change that they cannot adjust to. Does the member believe that the safeguards in the bill, which we have applied to people near the end of life, really would not be changed and be different had we intended to deal with people who have suffered recent paraplegic injuries?

[Murray Rankin, NDP, Victoria, BC]

Madam Speaker, I thank the hon. member for Mount Royal for his superb leadership as chair of the justice committee, which I have the honour to work with him on.

I understand that the Canadian Medical Association agrees with the bill. I have heard from so many doctors in my office who call constantly saying that they do not understand it. Frankly, the CMA is a trade organization for doctors. It is not the regulatory body that has to decide what to do when doctors run afoul of the professional standards being implemented in each of the territories.

I think that the constitutional constraints on us, under a criminal law power, to do some of the things that provinces can better properly do will address some of the very concerns that the member raises, such as whether we have an adequate reflection period, and the like. I am proud to see that, although these rules are not unanimous from from coast to coast to coast, they are fairly consistent. I think taken with Bill C-14, they will provide the kinds of safeguards that Canadians expect.

[Jane Philpott, Liberal, Minister of Health]

Madam Speaker, I want to say before I begin that I will be splitting my time with the hon. member for Montcalm.

I am pleased to be here today to continue our important discussion on Bill C-14 concerning medical assistance in dying.

We have seen the serious thought and deliberation that hon. senators have put into this bill over the past few weeks. It is now up to us to carefully examine the amendments that the Senate has presented.

Medical assistance in dying is only available in a very small number of jurisdictions around the world and it is brand new to Canada. What we are talking about with this bill is a fundamental change to social policy in this country. We are pursuing transformative change at the same time as we are facing incredible time pressure to put federal legislation in place. It is, therefore, critically important that we move forward with great care.

There are a number of paths that we could choose to follow with respect to medical assistance in dying in this country. I believe that the choice we have made with Bill C-14 represents the approach that is most appropriate and responsible for Canada, and here is why. It strikes a careful balance between respecting the autonomy of patients seeking assistance in dying and protecting vulnerable people. It would protect the conscience rights of providers and support those who choose to participate. It would put measures in place to study the legislation over time as we understand and gather further data to deal with the issues.

I would first like to bring to the attention of hon. members the ways in which the bill respects the autonomy of patients. Under this legislation, eligible patients approaching the end of their lives would be able to choose a peaceful medically assisted death. This represents a significant shift in the way we approach suffering at the end of life in this country. It provides patients with greater autonomy over their decisions.

The bill also improves access for patients. By allowing nurse practitioners to administer medical assistance in dying, the bill recognizes Canada's unique geographic and demographic realities. Nurse practitioners often work alone to provide vital health care services in underserved regions.

In addition to supporting access and autonomy, Bill C-14 also takes care to protect patients who may be vulnerable. When changing social policy, we must proceed with great caution if there is a chance that those who are most vulnerable among us may be negatively affected. Without appropriate safeguards, the availability of medical assistance in dying could pose threats to marginalized people and those who may lack access to adequate familial, social, or economic supports. This bill would establish robust safeguards and procedures to protect vulnerable persons from being encouraged or coerced into seeking medical assistance in dying.

It is important to recognize that there has been significant support in this piece of legislation from the health care sector, including the Canadian Association for Community Living, which includes 40 individual advocates and 50 organizations. It includes various medical associations, both provincially and federally, the Canadian Nurses Association, the Canadian Association of Advanced Practice Nurses, the Canadian Pharmacists Association, the Canadian Psychiatric Association, the Canadian Association of Social Workers, and many more.

This legislation also complies with the vulnerable persons standard, which I believe sends a strong message to all Canadians about our support for those among us who need most protection.

The bill recognizes that medical professionals have the right to follow their conscience and choose whether or not they want to participate in medical assistance in dying. For those who do choose to participate, the bill ensures that the doctors and nurse practitioners who administer this assistance will not be prosecuted. It also exonerates those who may assist, such as pharmacists and authorized nurses.

Finally, it outlines criteria to help support providers in assessing patients. It is important to keep in mind that health care providers are required to assess the condition of their patients on a regular, if not daily, basis. Assessing the level and type of suffering is already part of medical practice and it is very common in all end-of-life care. It is, for example, a crucial element in determining the best approaches to alleviate suffering in palliative care.

Our eligibility criteria and safeguards offer providers direction and flexibility within their field of expertise and scope of practice to make an assessment about the condition and circumstances of a patient seeking medical assistance in dying on a case by case basis.

Given the complexity and often personal nature of this issue, there is significant debate in terms of the correct approach from many different perspectives. What we have with Bill C-14 is an approach that would put a cautious assisted-dying framework in place while leaving the door open to adjust as we better understand more challenging issues. In the legislation, there is a commitment to independent studies on challenging issues that need to be investigated further before determining what policy considerations the government should make.

One thing is certain, these are issues that present real risks to people in vulnerable circumstances and highlight the complicated nature of balancing autonomy against the protection of vulnerable patients. There is also, of course, a mandatory parliamentary review of this legislation after five years.

I would be remiss if I did not reaffirm here today the importance of improving access to high quality palliative care for all Canadians. Our government has committed to investing in this area. I continue to work with provinces and territories to help support access to all options for care at the end of life.

The motion today has given thoughtful consideration to the work of the upper chamber. I thoroughly appreciated the opportunity to take questions for a two-hour period at the committee of the whole, in addition to the time that I appeared before the committee's pre-study.

There are two amendments made by the upper chamber where we respectfully disagree. As captured in the motion today, we as a government reviewed and sought a path forward that encompasses the Senate's amendments where possible, resulting in our agreement with the five remaining amendments. There is alternative text proposed to reflect the upper chamber's desire to recognize the vital importance of palliative care options for patients. As I have said repeatedly, this is a positive outcome if the result of this legislation allows tangible improvement to access palliative care in Canada.

We also have a responsibility to provide language in the legislation that health care professionals can understand in order to provide access to assisted dying. As is stated in the proposed message to the Senate, removing the criterion of the reasonable foreseeability of natural death would undermine the objectives of Bill C-14 to recognize the significant and continuing public health issue of suicide, to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill, or disabled. Bill C-14 strikes the right balance for Canadians between protection of vulnerable individuals and choice for those whose medical circumstances cause enduring and intolerable suffering.

In conclusion, I would like to underline to my fellow parliamentarians that the approach set out in Bill C-14 is the result of tremendous thought and deliberation over the course of many months. There have been extensive consultations over this past year on the issue of medical assistance in dying with Canadians, stakeholders, and relevant experts. The findings have been reviewed carefully to inform the legislation.

I hope both the House and the Senate are able to support the motion. I would like to thank, from the bottom of my heart, all the parliamentarians from both the upper and the lower chamber who have professionally and thoroughly debated this issue. It is a transformative social policy that governments debate once in a generation, and this piece of legislation is one of those remarkable debates. Make no mistake, this will be a dramatic change for Canada.

In the Carter decision, the Supreme Court acknowledged that it was up to Parliament to craft an appropriate regime. I believe we arrived at the best approach for our country.

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

Madam Speaker, the minister mentioned fundamental change and transformative change. Certainly, I think we agree that it is. Where we disagree is on whether it is a positive or a negative transformative change.

She referenced, different times, vulnerable persons in her comments. I just want to remind Canadians that in the preamble of the bill it clearly is looking at the possibility of extending physician-assisted suicide to those where mental illness is the sole underlying medical condition. I do not know if there is anyone more vulnerable. Another group of vulnerable people are those who might be coerced by relatives who may be beneficiaries. I cannot understand why the Liberal government would reject this amendment that was passed in the Senate.

Finally, she assures me that no doctor would be coerced into participating in physician-assisted suicide. Could she assure me that no medical doctor or health care institution would be forced to either participate or refer for physician-assisted suicide?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, I want to thank my hon. colleague for the time that he has committed to being here to debate this important matter.

I share his concerns over the protection of people who are facing mental illness. This is one of the fundamental reasons why we hope that he and his colleagues will support the motion that we have put forward in the House today. We are concerned with the Senate's recommendation for the removal of the clause that recommends that this be considered only in the face of natural death being reasonably foreseeable because of the fact that people with mental illness, among others, would not be adequately protected.

The member also talked about other safeguards that were suggested by the Senate. This piece of legislation was drafted in totality. The safeguards that are in place to recognize that no one would be coerced need to be seen in totality so that one piece or clause in particular does not adequately put those safeguards in place. My colleagues and I who have worked on this—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I am sorry to interrupt the member but I need to allow time for other questions. Maybe the minister could finish her thoughts on the next question.

Questions and comments. The hon. member for South Okanagan--West Kootenay.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, we have over the last few weeks heard reports from many experts that Kay Carter, whose case before the Supreme Court of Canada brought this important issue to us, would not be eligible for physician-assisted dying under Bill C-14 as it now stands.

I would like the minister to comment on that. Does she disagree with that position? Does it not reflect on the confusion that the bill as it has been crafted has caused in the debate?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, my colleague's question gives me an opportunity to reiterate again, as my colleague the Minister of Justice and I have said on numerous occasions, that we are absolutely clear on the fact that the two cases that were reviewed in the matter of Carter v. Canada are cases of people who would absolutely have been eligible under the legislation that is before the House today.

If the Carter decision is read carefully one will understand that it was clearly speaking to people who were facing end-of-life decisions. We are fundamentally affirming today that the people in question in that case would have met the criteria of Bill C-14 for medical assistance in dying.

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

Madam Speaker, my question is more open-ended. The minister is attempting to bring forward good, solid legislation that reinforces the fact that it will stand the test of time. It sets up a wonderful framework and enables us to deal with an important issue that Canadians want us to deal with.

I wonder if the minister could give us some concluding remarks.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Madam Speaker, this legislation would change the social fabric of this country. We need to think about how this legislation would affect the lives of individual Canadians as they face the end of their life. We are pleased to put forth a piece of legislation that we believe is the right approach for Canada.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I would first like to thank the Minister of Health for sharing her time with me. This clearly demonstrates that she believes in fair play and democracy, since she knows that I am opposed to the motion and the bill.

That being said, I am wondering how I will say everything I have to say in 10 minutes.

I will begin with the heart of the issue. The premise of the fundamental debate relates to our understanding of the principle of self-determination. Here are the main questions that the Department of Justice and the two ministers should have asked themselves. Why and on what grounds would we take away people's right to self-determination throughout their lives? When, even in urgent medical situations, no medical intervention can happen without a patient's free and informed consent, why and on what grounds would we take away people's right to self-determination at a time when they are enduring intolerable suffering, when they are about to die, when they are their most vulnerable?

The government says that it is in order to strike a balance, but that has never been proven, and the Supreme Court thought it was futile. Had it been referred to the Supreme Court, the bill would have been amended and considered unconstitutional. I imagine that is why the bill was never referred to the Supreme Court. It said that three rights had been violated by the total prohibition.

If we carefully study the Morgentaler ruling, we see that the court agreed to strike down the law that allowed abortions under certain conditions on the basis of just one right: the pregnant woman's right to security of the person. How can anyone seriously believe that the security of the person who is enduring intolerable suffering from a grievous and irremediable illness, disease, or disability would be protected by section 1 of the charter, which states that any limits must be reasonable in a free and democratic society?

It is quite unreasonable for a person who is among the most vulnerable in our society, the one who is suffering, to have to bear the burden of proving to the courts that he or she meets this criterion of reasonably foreseeable natural death or, as we saw recently, to have to go on a hunger strike in an attempt to meet the criterion.

I remind members that this criterion discriminates on the basis of age. The motion states “...to guard against death being seen as a solution to all forms of suffering, and to counter negative perceptions about the quality of life of persons who are elderly, ill or disabled...”. Whose negative perceptions? Where are these negative perceptions coming from, exactly? As far as I know, when someone has a degenerative disease, and this will come as no surprise to the Minister of Health, medical practitioners follow their patients' cases.

Is she assuming that medical practitioners, doctors, nurses, and health care professionals have a bias against their patients because of their age or social condition? Is she assuming that health care professionals have bad intentions?

If they have bad intentions, we should get rid of them. This rationale shows a bias against health care workers. Is she saying that seniors need to be protected from the people who care for them? This bill is a bad cut-and-paste version of the Quebec law.

We were able to move somewhat quickly here because Quebec has already gone through this, and its focus was the area of palliative care. Quebec achieved an amazing feat by not pitting euthanasia against palliative care and by ensuring that patients have access to a wide range of palliative care options.

Why would the bill limit itself to this one aspect or even to a degenerative disease like ALS? The idea is that death is reasonably foreseeable in this case, and this is where there is discrimination among degenerative diseases.

Who are we to pass judgment on someone's quality of life? It is not up to the doctor to pass judgment on a patient's quality of life or compare one life to another. These are basic principles of ethics.

We trust the health care workers who provide care, and obviously, they will see their patient's quality of life change over the course of a year. If the patient says he cannot take it any more, the request can be made.

Quebec's law is not a response to the Supreme Court's directive. Why? Because the Carter decision came afterward. Quebec's lawmakers sought to comply with the Criminal Code and respect each authority's prerogative in its own jurisdiction.

Now we have the Carter decision and this bad bill. Quebec's minister of health and social services was right when he told his doctors that this approach is unworkable and asked them to be prudent because this government lacked the courage to respond when the Supreme Court ordered us to create a framework for assisted suicide.

I read the motion and asked the minister a question today. The government is rejecting Senator Joyal's amendments, which are also those of the Bloc Québécois, the Green Party, and the NDP, who are calling for the elimination of this utterly vague criterion and a return to the terms in Carter, to what really matters for people who have a grievous and irremediable health condition that causes them persistent and intolerable suffering.

The motion says we struck the right balance and want to reject these amendments “to recognize the significant and continuing public health issue of suicide”. What is that all about? No one working in suicide intervention would ever confuse the two states.

As far as I know, a suicidal state is reversible. It is not irremediable, but indeed remediable. There are treatments for suicide. However, something like Alzheimer's is irremediable, as far as I know. Such is the confusion that was created here this morning, and the argument that was made.

That is the only argument that the Department of Justice is going to make at the Supreme Court and patients will have the burden of going to court in order to have access to medical assistance in dying. I will weigh my words carefully and say that I find that to be indecent.

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

Madam Speaker, I thank the member for weighing in on this issue and for his involvement in the discussion.

The Quebec legislation has, effectively, a terminal requirement. This federal legislation intervenes in an area that at least the Quebec government has called Quebec jurisdiction by changing the criteria.

I wonder if the member would agree with me that it would be more respectful to that particular sense of Quebec jurisdiction to include a clearer terminal requirement in the federal legislation?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, a consensus has emerged in Quebec that does not involve changing the federal legislation or the Criminal Code.

Clearly, any legislation that allows a range of end-of-life care and choices regarding end-of-life services and care must eventually be brought in line with the Carter decision, since there may be no legal vacuum.

However, I found it a little strange that my colleague said that there is no legal vacuum and we do not need to reach a decision on this today, when the guidelines provided for these situations are based on the Carter decision, which he opposes.

At this time, if Quebec wants to legislate on assisted suicide, if nothing happens here and all we have are the guidelines based on the Carter decision, Quebec would have to rely on those guidelines and what has been done.

It is not a question of imposing the Quebec law and trying to say that it solves all the problems. That is definitely not the intention.

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

Madam Speaker, during this whole debate around assisted dying, there has been a great deal of emphasis, justifiably so, put on the issue of palliative care. This is something that the national government, through the budget and a commitment toward a new health care accord, is trying to focus more attention on, that we do need to spend more energy and more resources on trying to develop a national palliative care system, in fact.

I realize it is a bit off topic as opposed to the specific bill, but it is something that has been debated quite extensively, and I am very much interested in the Bloc's thoughts on a health care accord and the importance of that and coming up with a national palliative care program.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, any health care accord that respects Quebec's prerogatives would be most welcome. Since the devil is always in the details, we would have to see what it says.

Getting back to the debate, I would say that palliative care does not address all the problems associated with the end of life. That is why, in some circumstances, people who are dying ask for an assisted death because there is no way to relieve their pain. Certain illnesses and certain cancers are impervious to pain medication.

In that regard, we wish that the Liberal Party would have had the courage to bring forward legislation that properly addressed that whole issue, in the same way that Quebec has a well-defined framework for end-of-life care and assisted suicide, while not confusing that with a suicidal state.

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

Madam Speaker, I will be splitting my time with the hon. member for Sherwood Park—Fort Saskatchewan.

I have had the privilege of following, from a distance, the proceedings in the Senate over these last days. I am disappointed that a number of the options that were given to the Senate were not adopted.

Senator Plett's amendment to make it a criminal offence for anyone to compel an individual, organization, or medical practitioner to provide medical assistance in dying or to refer was rejected by the Senate.

I wish I could share the optimism of our Minister of Health when she assured me a few minutes ago that no one would be compelled to participate in this. I do not share that optimism. I am hopeful I am wrong on that. I am hopeful there will never be a case where a medical professional, a health care worker, a health care institution will be obligated to participate or to refer for this practice when they find it morally objectionable.

The other amendment Senator Plett put forward was adopted by the Senate, however, rejected by the government today in its response. That is the amendment relating to not allowing a beneficiary of a person who is seeking medical assistance in dying from assisting that person.

It seems quite clear to me that if we are to protect vulnerable people, this was one of the key points that needed to be adopted. By rejecting this amendment that was passed by Senate, we are actually increasing vulnerability. That is a sad result of rejecting this amendment.

It goes without saying that this is a very sad day, a disappointing day for me. This is a day when choices will be made that will affect generations to come, and it is without question the most important choice that I and most of my colleagues will make in our parliamentary careers.

It is disappointing on two points. First, it is disappointing to see the activism of the Supreme Court. I mentioned earlier in my comments on this topic that it was unfortunate the Supreme Court of Canada had taken it upon itself to force legislation to be written which would overturn hundreds of centuries of our understanding of the intrinsic value and dignity of every human life. The Supreme Court has done this, completely rejecting the fact that as elected members of the House, we have rejected initiatives to legalize physician-assisted suicide on at least 15 occasions since 1991, the most recent one in 2010 by a vote of 59 to 226.

The other reason this action is disappointing for me is because of the many years I have worked on the issue of suicide prevention. I have worked with people who have been left to suffer the aftermath of suicide, parents who have lost children, children who have lost parents, and more. To know there are groups across Canada today that are working very hard to prevent suicide, to save lives, and to see we are now, in a way, normalizing suicidal behaviour is disappointing.

Bill C-300 was an initiative that the House passed almost unanimously, calling on the federal government to initiate a federal framework for suicide prevention. Just a few weeks ago, the Minister of Health indicated that the bill was almost ready to be fully implemented by the Public Health of Canada.

On one hand, we are working as hard as we can to prevent suicide, which I applaud and will continue to give my efforts to. On the other hand, it appears that we have given up and we are allowing those who are losing hope to actually access assisted suicide.

Ten Canadians each day lose their life to suicide. In Canada, groups are working hard on the ground to prevent suicide. Mental health care workers, experts, are providing safe talk training so front-line workers, such as teachers and our volunteers in our minor sports programs, can observe these first signs of suicidal ideation, and intervene with the intent of restoring hope to that person who has lost hope and is now in despair. Their motivation has always been to save lives.

Now, to turn 180 degrees and begin the path towards normalization of suicide, is a tragic course, a tragic course of action for all of Canada.

Again, I want to quote from an expert in this field. Aaron Kheriaty, an associate professor of psychiatry and director of the medical ethics program at the University of California, Irvine school of medicine, states:

The debate over doctor-assisted suicide is often framed as an issue of personal autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who — assuming they are of sound mind — are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences.

What if it turns out that the individuals who make this choice in fact are influencing the actions of those who follow?

Professor Kheriaty goes on to report that in states where physician-assisted suicide has been legalized, there has been an increase in suicides of 16.3% overall, but among those over 65 an increase of 14.5%. He further states:

[These] results should not [be surprising to] anyone familiar with the literature on the social contagion effects of suicidal behavior. You don’t discourage suicide by assisting suicide....

...Aside from publicized cases, there is evidence that suicidal behavior tends to spread person to person through social networks, up to three “degrees of separation” away. So my decision to take my own life would affect not just my friends’ risk of doing the same, but even my friends’ friends’ friends. No person is an island.

Finally, it is widely acknowledged that the law is a teacher: Laws shape the ethos of a culture by affecting cultural attitudes toward certain behaviors and influencing moral norms. Laws permitting physician-assisted suicide send a message that, under especially difficult circumstances, some lives are not worth living — and that suicide is a reasonable or appropriate way out. This is a message that will be heard not just by those with a terminal illness but also by anyone tempted to think he or she cannot go on any longer.

Debates [around] physician-assisted suicide raise broad questions about our societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?

I believe life is to be chosen over what some would call “death with dignity”. There is nothing dignified about deciding someone's life is not worth living. If a patient has a need, let us address it. Our goal should be to eliminate the problem, not the patient.

It is my firm belief that the House and the current government should be invoking the notwithstanding clause in order to protect Canadians. For thousands of years, all caring societies have agreed that it is not okay to kill another human being. We can try to soften that language. We can call it physician-assisted death. We can call it medical assistance in dying. We can use any euphemism we want, but the reality does not change.

Today, we are intentionally throwing away the wisdom of our faith foundations and the wisdom of centuries of civilization. My fear is that in a few short years, we, our children, and our grandchildren will live to see the folly of allowing physician-assisted suicide.

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

Madam Speaker, I indicated to the member earlier that he was fairly persistent in dealing with this issue over time. I respect his comments although I do not necessarily agree with them.

At the conclusion of the member's remarks, he made reference to using the notwithstanding clause. We need to recognize that we did get a Supreme Court of Canada decision in which all nine Superior Court judges recognized we needed to bring in legislation. That should also be factored into this. I know there have been petitions, even a petition in my own area, regarding the notwithstanding clause. The minister did a fantastic job in explaining why we needed the legislation and how it would establish the legal framework. I believe it will stand a charter test.

My question for the member is with respect to how the notwithstanding clause could be used. In this situation, I do not necessarily believe it is warranted.

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

Madam Speaker, I hope my colleague heard my opening remarks when I referred to the unfortunate activism of the Supreme Court of Canada. We have seen it on this issue. We saw it just a few days ago in relation to some sexual behaviour with animals. All of these things are not the job of the Supreme Court. This House is elected to represent the Canadian population. It is up to us to decide societal norms. It is not up to the Supreme Court to make that decision.

However, as it relates to this specific situation, many times in the House we have referred to the fact that we are under a time crunch. Invoking the notwithstanding clause would simply have given Parliament up to five years. It did not need to take that long if it did not want to, but Parliament would not have been rushed into making a decision in three months, a decision that takes much longer.

In the end, we are going to be sorry for the decisions we are making. In spite of the attempts to get this as good as we can, it is still a bad law.

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

Madam Speaker, I would like to thank my colleague for his speech. I had the privilege of sitting with him on the Special Joint Committee on Physician-Assisted Dying. This committee's meetings were marked by respect and a willingness to listen, and I was able to better understand my colleague's reasoning with respect to his conscience.

However, for me, medical assistance in dying is a choice. I believe that if someone is not comfortable with it, they simply do not have to ask for it.

My colleague finished his speech by talking about the wisdom of centuries of civilization. I have been dealing with this issue since January, and my fellow Canadians have been telling me that civilization is at the point that individuals can make decisions about their own lives.

Does my colleague not believe that we must let Canadians make decisions about their own lives?