Mr. Speaker, this is the second time I have had the opportunity to speak to this legislation, Bill C-7, an act to amend the Criminal Code, medical assistance in dying, due to the Liberals proroguing Parliament. Unfortunately, my earlier concerns, such as the legislation going above and beyond the Superior Court of Quebec decision, have not been remedied. I was also on the justice committee when this was being dealt with before.
I have long believed the place for drafting legislation is in Parliament so I will not criticize the government for tabling this legislation. My critique of the government is it is using the Superior Court of Quebec decision to make other amendments to Bill C-14 instead of using the automatic five-year review to do so, which was spoken about here earlier.
No one better understands the reasons why this legislation is needed to respond to the Quebec Superior Court decision than the current Liberal Minister of Justice. In the previous Parliament, he voted against his own government's legislation because he foresaw that a court would strike down the previous provisions as he felt they were too rigid.
The member for Vancouver Granville, the then former minister of justice who drafted Bill C-14 at the time, was aware of this criticism and spoke directly to that issue in her opening remarks at the justice committee back in May 2016. She said, “In terms of eligibility, I am aware of the requirements that a person's natural death be 'reasonably foreseeable' has received some attention, including in terms of how it relates to the Carter decision. I would like to address these concerns.”
She went on to say that, “A person can be approaching a natural death based on medical circumstances that are not directly related to a serious, incurable illness. As well, eligibility does not depend on a person having a given amount of time remaining, such as a certain number of weeks or months to live, as in the United States.”
It was clear from her remarks she felt Bill C-14, the predecessor to this bill, struck the right balance.
As we are all too aware, there are always unique situations where the law cannot accurately predict every scenario. The former minister of justice understood the complexities and challenges the families, doctors and patients were going to face with this new MAID regime. She went to say at committee:
Reasonable foreseeability of death is ultimately a medical decision, and not a legal one, to be made by taking into account all of the person's medical circumstances, including the types and number of medical conditions, frailty, age, etc..... By defining the term “grievous and irremediable medical condition”, the bill would ensure that all competent adults who are in an irreversible decline while on a path toward their death would be able to choose a peaceful, medically assisted death, whether or not they suffer from a fatal or terminal condition.
The word that has caused considerable consternation with both individuals seeking MAID and their doctors is “competent”. As with many illnesses, the drugs needed to either treat or provide comfort can impede one's competencies. This will be an important issue as it relates to the legislation as the government is creating a process for advance requests for persons newly diagnosed with a condition that could affect their decision-making capacity in the future.
As Jane Philpott, the former health minister, said when drafting the original MAID legislation in 2016:
We faced similar challenges in considering the issue of advance directives. The Supreme Court did not deal with this issue in Carter, and the views of Canadians and stakeholders, as you know, are divided. I understand the hardship for those Canadians who fear that after being diagnosed with a disease such as dementia they may experience a decline that could compromise their dignity. This has led to pleas to allow people to make requests for medical assistance in dying well in advance of the time when the person is no longer competent to make or reaffirm a desire to accelerate their own death.
While I agree, I also agree that once this legislation is referred to the justice committee it would be prudent to revisit this issue with medical professionals who are experts on Alzheimer's and dementia-related illnesses.
We must bring in families and those who understand these types of illnesses so we can think through as many scenarios as possible. I would prefer Parliament get this right rather than a court striking down the legislation in the future as it could lead to the situation we find ourselves in today.
The other issue I want to touch on stems from the Truchon decision. The Superior Court of Quebec struck down Bill C-14's provision that death had to be reasonably foreseeable. One could argue the government should have appealed the superior court decision, as we have spoken about in other speeches and questions tonight. It would not be an unusual step as the Government of Canada appeals all sorts of lower court decisions.
While I was not expected to be consulted on the government's response to the Truchon case, there has been very little public discussion from the Liberals about the likelihood of prevailing at the Supreme Court. My only question would be this. If the government did appeal to the Supreme Court, could it have gotten a more limited and narrow ruling on the implications of deleting the reasonably foreseeable clause?
By completely removing this clause, even with a new set of safeguards, it will expand the list of people who might be eligible for MAID rather than just dealing with the specific concern raised in the Truchon case. The very reason the reasonably foreseeable clause was put in the original legislation was that the former ministers wanted a balance between personal autonomy and the protection of the vulnerable.
Obviously the Superior Court of Quebec did not approve of the balance the Liberals sought in Bill C-14. However, in response, we must be mindful of the unintended consequences of this legislation. I know every member of Parliament has been contacted by their constituents about the implications of removing reasonably foreseeable criteria.
There are varying degrees of concern, ranging from moral and ethical grounds to concerns about the role of the state in sanctioning MAID for individuals who are doing so out of the lack of proper palliative care services. The government has decided in this bill to continue to allow doctors and individuals to decide what constitutes a grievous and irremediable medical condition rather than provide a prescriptive list of eligibility criteria. As someone who believes in individual rights and in the judgment of medical experts, I agree with this approach. My only concern is that we have left it too vague.
The government could have eliminated the reasonably foreseeable clause and replaced the original criteria with something that would be deemed constitutional rather than what we have before us today. There are those with apprehensions that proceeding this way will lead to situations where individuals will seek MAID and even be able to proceed for reasons no one in Parliament intended it to. I, for one, would like to see the law as written and intended by the drafters be carried out accordingly.
That is one of my concerns that must be answered fully before we pass the legislation and send it to the Senate. While the legislation explicitly states that having a mental illness is not a serious and incurable illness, disease or disability, we must be prepared to withstand that court challenge.
To refer back to the 2016 debate on MAID, Jane Philpott, at the justice committee, said, “There is no denying that mental illness can cause profound suffering. However, illnesses such as chronic depression, cognitive disorders and schizophrenia raise particular concerns with respect to the matter of informed decision making.”
It goes without saying that there are deep divisions on the overall issue of MAID. What we find in this bill goes much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is using safeguards which, I might add, is the actual language found within the presentation with which department officials briefed MPs. As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this would be changed to one independent witness. I believe it is incumbent on the government to justify this change and outline the rationale why it needed to be amended.
Last, the government is also be removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required to be in compliance with the Superior Court of Quebec decision.
I have listened closely to the concerns of constituents about the bill, I support it going to committee for scrutiny and clarity. I want government to know I am committed to working with them constructively on the legislation.