No worries, Mr. Speaker. With virtual Parliament, all members of the House of Commons and, of course, you, Mr. Speaker, and your team, should be really proud of the work that we have done to keep Parliament functioning.
I am so happy to speak to the House today to address Bill C-7. I have been listening to the debate quite closely. I have to say that I am so impressed by the passion and compassion that I have heard in all of my colleagues' voices in talking about this very personal and very emotional topic.
In responding to the ruling of the Superior Court of Quebec on Truchon, we have had the opportunity to consider measures for which there is strong public support, and that is why we are proposing changes that will help clarify and strengthen Canada's medical assistance in dying legislation that is in place today.
Canadians have shared their views since we had passed the original legislation in 2016. Earlier this year, I had the opportunity to listen to their opinions and ideas. I also listened to the practitioners who have been providing these services over the past four years. I have to say, on a personal note, that the stories of both groups really were very moving, but particularly from the practitioners who have been using the legislation to provide choice to patients who oftentimes had been suffering terminally for a very long time. It is very clear that their compassion and expertise is something we should all be very proud of and grateful for as Canadians. However, it is also clear, through those conversations, that certain aspects of the current legislation could be altered to improve access, protect the vulnerable and respect this personal choice that is at the foundation of the legislation. With this bill, I think that we achieve a balanced approach that reflects the best interest of all Canadians.
The proposed changes to this bill have been informed by years of study and consultation. In December, 2016, we asked the Council of Canadian Academies to review three types of requests for medical assistance in dying that are currently outside the scope of the law: requests by mature minors, advance requests and requests where a mental disorder is the sole underlying condition. As part of our analysis, we also consulted a number of other sources, including evidence submitted before the court in Truchon, as well as domestic and international research.
Medical assistance in dying is a complex and deeply personal issue, as so many of my colleagues have illustrated in their remarks. We knew that before going forward with changes to the current law, we needed to hear from Canadians. We held public and online consultations for Canadians to participate to complement our discussions among cabinet ministers, medical experts and other stakeholders in the country.
Protecting the safety of vulnerable people, a focus of many of the comments today, while respecting the autonomy of Canadians, another key aspect that was so important in our consultations, remain our central objectives. That is why the bill proposes a two-track approach to safeguards based on whether or not a person's death is reasonably foreseeable. The bill would no longer make reasonably foreseeable natural death the basis for determining eligibility, but it would use it to establish whether a more rigorous set of safeguards should be applied.
If a person's death is reasonably foreseeable, a set of safeguards similar to the existing regime would apply, but after hearing Canadians' feedback on the barriers that some of those original safeguards pose to those seeking medical assistance in dying, some of the conditions have been changed. I will expand on the specifics of the bill's proposed changes to these safeguards in this case.
For those whose death is reasonably foreseeable, we would ease some of the pre-existing safeguards that we know have not served their purpose of protection. For example, under the current system, there is a requirement for a 10-day reflection period. Health care providers and family members, those who have been through this and have shared their loved ones' stories, have told us that the safeguard often prolongs the suffering of individuals who have already given extensive consideration to their decision to request medical assistance in dying. As a result, the proposed bill would remove this requirement.
During the round table discussions, we also heard that the existing requirement for two independent witnesses posed a barrier to those seeking medical assistance in dying, especially for those living in a care home or institution. We proposed only requiring one witness and allowing this witness to be a care provider. Those involved in assessing or providing medical assistance in dying would still not be eligible as witnesses.
Last, we heard from Canadians about the waiver of final consent.
Under the current legislation, a practitioner must ensure the person seeking and deemed eligible for MAID gives their express consent immediately before providing MAID. This is often referred to as the final consent, and provides final confirmation of the person's desire to proceed with MAID.
This safeguard also prohibits MAID for individuals who have lost the capacity to provide final consent, regardless of how sure and definitive they were about their intention when they had capacity. This safeguard unintentionally created situations for individuals who had chosen to end their lives earlier than they wanted out of fear of losing the opportunity to receive MAID because of an impending loss of capacity.
I know many of members are aware and have spoken about Audrey Parker, who last year died and used her final days to advocate for changes to this very part of the legislation. In one of her last posts, she said, “the law has forced me to play a cruel game of chicken... I would like nothing more than to make it to Christmas, but if I become incompetent along the way, I will lose out on my choice of a beautiful, peaceful and, best of all, pain-free.”
Inspired by Audrey's memory, we are proposing to include a waiver of final consent for persons whose death is reasonably foreseeable, but who are at risk of losing decision-making capacity. As proposed in the bill, the individual would be able to provide written consent for their practitioner to administer MAID on a specified date.
In addition to easing certain safeguards, the bill also proposes strengthening others for those whose death is not reasonably foreseeable. We heard concerns from stakeholders and Canadians alike that eliminating the reasonable foreseeability of natural death requirement could result in increased risk for some people. Their concern is for people who are suffering, but not at the end of their life, who might make a choice that is not fully informed, with respect to treatments and supports. We think it is important while improving access to ensure vulnerable individuals are protected.
For example, the bill proposes a minimum period of 90 days for assessing the MAID requests in these circumstances. This period would allow for exploration, discussion and consideration of options by the person seeking MAID in collaboration with his or her practitioner. The bill would also require that the people requesting MAID in this circumstance be provided with information about the available counselling, mental health supports, disability supports and palliative care to ensure he or she were making an informed consent.
Following the Truchon decision, some have expressed concerns about individuals suffering solely from mental illness receiving MAID. Many clinicians argue that the trajectory of mental illnesses is harder to predict than that of physical disease. In light of this consideration, the wording of the bill precludes individuals suffering solely from a mental illness from accessing MAID. This proposed change does not mean that people will be excluded if they have a mental illness; it means that mental illness cannot be the only underlying medical condition. We anticipate that the issue of mental illness and medical assistance in dying will be further explored as part of the parliamentary review process.
There is also an agreement among experts that allowing advance requests for people with illnesses like Alzheimer's disease is very complex and would require careful consideration and consultation before it could be implemented.
During round table consultations, I heard from health care providers who were worried that because they had seen patients who, as their condition progressed, might not have had the same desire for MAID as when they were first diagnosed, it would be very difficult to assess these types of requests. The Council of Canadian Academies expert panel report on advance requests came to the same conclusion. For this reason we believe this topic is deserving of deeper examination through a parliamentary review. We need to approach this area with the careful consideration that it warrants.
Since MAID legislation was first enacted in 2016, nearly 14,000 Canadians have chosen the option of a medically-assisted death, and this is not unexpected. We have seen a gradual increase in the numbers over the last three years, and Canada's experience is in line with other similar regimes around the world.
This is why we are also proposing changes to expand data collection to help provide a more complete picture of MAID in Canada. Today we are taking steps to clarify and add precision to Canada's medical assistance in dying legislation to respect the issues and the concerns raised by participants and numerous consultations about the need to place the personal autonomy and protection of vulnerable persons at the centre and the heart of this legislation.
I believe this legislation would improve the existing legislation, especially for those people whose health conditions lead them to consider this difficult decision. I urge all members of the House to support Bill C-7.