Madam Speaker, I wish to rise today to speak on behalf of the NDP in respect of Bill C-418, the initiative of the hon. member for Cypress Hills—Grasslands.
We must oppose this bill. We are concerned that it creates a loophole whereby health professionals could deny a referral to a patient seeking medical assistance in dying. I want to be very clear at the outset. I had the honour of representing our party, both on the special joint committee that dealt with medical assistance in dying and the justice committee.
At that time, I put an amendment before the justice committee to ensure that the rights of health care professionals would be respected, that no health care worker should ever be compelled to provide medical assistance in dying. I am proud of that contribution. I am proud that it became part of the law.
However, what is equally important is that there be the ability, always, for the patient to exercise his or her constitutional right to avail themself of medical assistance in dying. In a contest between a physician and that patient, the law is crystal clear. It is the patient's right that must prevail. I will come back to that in a moment.
Therefore, this no doubt well-intentioned bill before us uses very vague language that talks about directly or indirectly doing certain things. That, of course, is the problem with this bill. We in the NDP have always championed the rights of health care professionals, but we must address this critical balance.
Part of ensuring there is what is called an “effective referral” is that the doctors, the health care professionals, are able to find another route, but that, nonetheless, the patient always has, at the end of the day, the final ability to avail themself of that service. It is not enough to say they can self-refer themselves, that they can look in a phone book or go to a website. As I will illustrate in a moment, it just does not work that way.
In a recent Ontario Court of Appeal decision in 2019, a judge found that the rights of the patient must prevail over the rights of the physician. There must be what the Ontario court terms an “effective referral”. That term was defined as follows:
A referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency.
The quote that I find the most important in the entire decision is as follows:
The interests of patients come first, and physicians have a duty not to abandon their patients.
That is the Court of Appeal speaking.
It is an unimaginably difficult situation for a person who is by definition in severe pain and interminable suffering to be challenged to find a particular doctor in circumstances where they have less resources than would normally be available to them. They have a relationship with their physician. Let us say that physician does not accept the legitimacy of the law of Canada and has a conscientious reason for opposing it, which is, as I said at the outset, certainly their right. There are issues of confidentiality. Not everyone can simply go to their family and say, “Can you assist?” or has the wherewithal at the end of life to go to a website or to a telephone book to try to find that.
That is why the court of appeal, in its wisdom, made the statement that I just read. A doctor, in other words, cannot effectively cut their patient adrift.
It also must be said that this particular bill, and that case to which I referred, have significant implications for a woman's right to choose. That, as well, is something for which an effective referral is required at law. The Women's Legal Education and Action Fund intervened in that case, and after speaking about effective referral in the terms I just raised, said the following:
The Court agreed with LEAF that “due to historic inequalities in accessing the medical system, many women are dependent on physician approval to access reproductive services.” Since physicians act as gatekeepers to the system, an effective referral may be the only channel through which these women can access the care they need.
Therefore, there are implications of the bill that need to be understood as broader than the way it might be considered on its face.
We want to ensure what we did in those difficult debates about medical assistance in dying becomes a reality for people at end of life. No matter where they live in Canada, these services should be available.
Where I live on Vancouver Island, we have the highest uptake of this service in the country by a considerable amount, because the medical system has responded. Many physicians are providing this service. However, from talking to colleagues in places such as Atlantic Canada, I know it is an entirely different world elsewhere. As Canadians, we all have the same constitutional rights. The disparity is unacceptable, but that is the world in which we live. We have to do better.
Reasonable access, if that is what the law requires, is simply not a reality in many rural and remote parts of our country. It cannot be that a doctor can thwart the ability of patients ability to avail themselves of that service.
Some people may not want to talk to anyone other than their family doctor or a particular physician because of confidentiality issues. They may not even want their parents or children to know that they are considering this.
It is my belief that the bill, as it exists today, will disrupt the very careful balance that was achieved in this Parliament regarding physician assisted in dying.
I would like to share with the House an anecdote that was provided to me by a woman named Shanaaz Gokool, who is the chief executive officer of Dying With Dignity Canada. She tells a story about a gentleman who is only identified by his initials, R.A.
In 2018, R.A.'s mother was dying of terminal cancer. R.A. was her primary caregiver. He was an educated, loving son who was financially secure and able to take a leave of absence from work to provide daily care for his mother. The family was from another country and English was not their first language. His mother requested help with physician assisted dying, but her doctor did not think that was appropriate and declined to provide a referral.
R.A. did an Internet search and found somebody in a hospital nearby. The hospital sent him an email with more information about how to use the service, but he was overwhelmed in caring for his mother and missed the email. Some three weeks later, he finally got more information and called Dying With Dignity to witness his mother's MAID request. She was found eligible and a number of months after she first asked her primary care physician to help, the service was made available to her.
Unfortunately, days before she was to receive medical assistance in dying, she died a terrible death, essentially choking on and drowning in her own vomit, when her son looked away briefly.
When he was to testify to this before the Ontario Court of Appeal, he went back to check the email that was sent to him by the hospital care coordinator. It was a heart-breaking moment when he realized the email had the email address and phone number for the Ontario medical assistance in dying care coordination service. He had the information all along, but he was so busy caring for his mother he did not see the details in the original email.
The point of the story is that sometimes people need a physician or a health care professional to provide them with an effective service. This story is a tragic example of where that was not done. Sometimes a phone number or web address is simply not enough.
We believe that coercion and intimidation are always wrong. However, it is important we keep the balance that was carefully struck in this Parliament when we took the step of creating a regime for Canadians to avail themselves of their constitutional right to medical assistance in dying in certain circumstances. We should keep that balance and not destroy it.
