Debates of Oct. 28th, 2020

Criminal Code

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

Mr. Speaker, I thank my colleague for his speech.

I have a simple question. Bill C-7 is very important, and all of the questions it raises are very delicate. However, right now, there are people who are expecting us and the federal government to pass legislation.

Does my colleague not agree that we could have used the five weeks during which the government prorogued the House to pass this bill and respond to the wishes of those who are waiting on the federal government so that they can take the next steps?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, I acknowledge what the member has said. This legislation is very urgent. Medical assistance in dying is a very complex and deeply personal issue, as the member has already stated. The sad reality is that death is the only way for many people who are suffering. We have tried our best by way of consultation all over Canada. People from different cultures, races and backgrounds were directly involved in the January 2020 public consultation process. The minister along with several other distinguished members held round table discussions across the country with 125 experts and stakeholders.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I am pleased to see the member for Brampton Centre standing and speaking on this. I wonder if he would agree with me, though, that there is a task that we have left undone here. The original legislation required a review of the broader issues around medical assistance in dying and this review has yet to start.

I put a motion on the Order Paper suggesting that committee be established without delay. Would the member support setting up such a broad review?

[Ramesh Sangha, Liberal, Brampton Centre, ON]

Mr. Speaker, the issue at hand today is very delicate. Everybody knows that. This needs to be discussed at length. For everyone listening to this debate, those who are in Parliament deliberating this issue are taking deep steps to resolve all the issues so we can bring back legislation, and in front of the public.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, I appreciate this opportunity to outline the proposed amendments to the federal legislation on assisted dying. This bill responds to the Superior Court of Québec's ruling last year in Truchon by removing the requirement that a person's natural death be reasonably foreseeable in order to be eligible for medical assistance in dying. The proposed amendments were developed with the goal of supporting autonomy and choice for those Canadians with non-terminal conditions who are suffering intolerably, while addressing the potential risks of expanded eligibility for medically assisted death.

Our government consulted widely on this issue. We examined the evidence submitted before the court. We looked at domestic and international research. We compared our experience to other assisted dying regimes from around the world. We consulted with constituents, including 300,000 individuals who took part in our online public consultation, and we asked health care professionals about their practical experience with MAID over the past few years.

The bill reflects some important changes based on what we heard. In light of the need to respect the autonomy of Canadians seeking MAID, while providing protections for vulnerable people, the bill proposes the application of a two-track system of safeguards. While the bill no longer uses a reasonably foreseeable natural death as a basis for determining eligibility, it does use it as a basis for determining whether to apply a more rigorous set of safeguards. If a person's death is reasonably foreseeable, a set of safeguards akin to the existing regime would apply. However, some of the original safeguards have been eased in light of the feedback we received.

For example, there was overwhelming support for changing the witness requirement from two witnesses to one. Providers consistently reported that finding two independent witnesses posed a barrier to those seeking MAID, especially for anyone living in a care home with a limited social network. The sole purpose of the witness is to confirm that a person seeking MAID has signed the request themselves. To be clear, the witness has no role in confirming whether the request was made voluntarily, nor does the witness have any role in assessing whether the person's condition makes them eligible for MAID. Rather, it is the MAID provider who undertakes the eligibility assessment and ensures that the person requesting MAID is making the request freely and not in response to external pressures.

The proposed bill responds to these concerns and eases this requirement to one witness. It also allows for a witness to be someone who is paid to provide personal support or health care services. Anyone who is in a position to benefit in any way from the person's death, as a beneficiary to a will or in any other material way, would not qualify as an independent witness.

Health care providers and the families of people who receive MAID also told us that the mandatory 10-day wait period often results in prolonged suffering for individuals who had already put careful and extensive thought into their decision. As a result, the proposed bill would remove this requirement.

I would like to address how the bill would protect Canadians, while satisfying the requirement from the Truchon ruling to eliminate the reasonable foreseeability of natural death clause. On this issue, we received feedback from practitioners and stakeholders who expressed concerns that people who are suffering but not at the end of life could make decisions about MAID that are not fully informed with respect to all available treatments and supports.

On this very sensitive subject, I consulted with my own constituents in Mississauga—Streetsville. I found one of the strongest proponents of these MAID reforms in Mr. Paul Irwin, who suffers from Parkinson's disease. Although this horrible affliction is slowly robbing Mr. Irwin of his neurological functions, I can assure the House that his mind remains razor sharp. Mr. Irwin has explored all available treatments and supports, and he has consulted a wide range of medical professionals. There is no doubt in Mr. Irwin's mind that he would like to control when and how he passes as a recipient of MAID. It is not a decision that individuals in Mr. Irwin's circumstances take lightly or without having weighed all alternatives. I applaud Mr. Irwin's courage.

In order to afford individuals like Mr. Irwin the dignity they deserve, we have added safeguards in lieu of foreseeable natural death that would apply only to requests where a person's death is not reasonably foreseeable. These strengthened safeguards are designed to support informed decision-making and the consistent application of good medical practice. For example, the bill proposes a 90-day minimum assessment period to offer an exploration of all relevant aspects of the person's situation.

We heard very clearly through the consultation process that Canadians are concerned about implementing a requirement for specialist consultations in assessments of MAID. We know that in some parts of the country, such as rural and remote communities, a consultation with a specialist can be harder to arrange. We do not want to create unnecessary barriers. This is why the bill proposes that, for people whose death is not reasonably foreseeable, one of the assessments will be done by a provider with expertise in the person's medical condition but not necessarily a specialist. We recognize that many health care providers have special training and certifications that qualify them to assess a person's particular medical circumstances, even if they are not specialists.

The bill also proposes that the practitioners and the patient would need to agree that reasonable options to relieve the patient's suffering had been seriously considered. This safeguard respects an individual's autonomy, while at the same time underscoring the importance of a fully informed, decision-making process.

In addition, following the Truchon decision, some have expressed concerns that individuals suffering solely from a mental illness could receive MAID. For example, many clinicians argue that the trajectory of mental illness is harder to predict than that of physical diseases, rendering it impossible to determine when or if a mental illness can be considered irremediable as required by MAID legislation. Another concern is the challenge of conducting capacity assessments, given that the symptoms of mental illnesses can affect a person's ability to understand and appreciate the nature and consequences of treatment decisions.

In light of these important concerns, the wording of the bill would preclude individuals suffering solely from a mental illness from accessing MAID. The decision to include this wording reflects the complexity of this problem and the need to fully consider the potential consequences of permitting MAID for individuals with a mental illness to make sure that vulnerable persons are not put at risk. We anticipate that this issue will be further explored as part of the parliamentary review.

I would now like to turn my attention to the waiver of final consent.

The current law includes a procedural safeguard that requires the practitioner to ensure that the person gives their express consent immediately before providing MAID. This is often referred to as “final consent” and is significant for health care providers as it provides a 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 definitive they were about their intention when they had capacity, made the request and were deemed eligible.

Unfortunately, the requirement for final consent had the unintended consequence of encouraging some individuals to receive MAID earlier than they would have liked out of fear of losing capacity to consent prior to their preferred date. This was the situation faced by Audrey Parker. Ms. Parker was very clear about her desire to share one last Christmas with her family, but felt compelled to receive MAID almost two months earlier than anticipated in order to ensure that she was still capable of providing final consent for the procedure.

In a similar example that is a bit closer to home, my friend and legislative assistant recently lost his father. A MAID recipient, Wah-Lit “Edward” Lui passed away peacefully at home on September 23, 2020. Once doctors had diagnosed Edward with a rare complication of terminal cancer, he had little choice but to immediately initiate the MAID process, which had long been his expressed desire, for fear of losing the ability to final consent over the next few days. Thus, Andrew and his family had a mere 24 hours to say their final goodbyes.

Under the proposed amendments, individuals who have been found eligible to receive MAID and whose death is reasonably foreseeable, but who may be at risk of losing decision-making capacity, could waive the requirement to provide final consent before the procedure. For families like the Parkers and the Luis all across Canada, allowing MAID to proceed in the absence of the ability to provide final consent is simply the right thing to do.

As a further safeguard, in order to waive this requirement, an individual would need to have been assessed and approved for MAID, and be at or very close to the end of life. As proposed in the bill, the individual would provide written consent for the practitioner to administer MAID on a specified date.

In conclusion, the proposed amendments in the bill take into account the lessons we have learned through consultations and respond to the immediate task of following up on the Truchon decision. With this revised legislative package, our government has gone a very long way to respect and support the autonomy of Canadians who wish to consider a medically assisted death, while taking seriously our responsibility to protect vulnerable people.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Mr. Speaker, I have a question for my colleague in regard to respecting the conscience rights of physicians across our nation. I understand this is provincial jurisdiction, yet the government does tend to express its views when it sees value in that and it has committed to a national palliative care strategy.

For physicians, does he not see the need to allow them to have the right to make the determination of whether they want to participate either directly or indirectly in MAID?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, physicians do have the ability to opt out. I believe that in a country like Canada, which is among the best in the world, it is imperative we provide individuals with the best health care Canadians deserve. I do not think we can provide that in good conscience without providing a system like MAID. I would even go as far as to say it is a moral imperative that Canadians have this kind of health care available to them.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, I would like to ask the member about same-day death, which the bill would allow for. There was a definite waiting period, which could have been waived in special circumstances, but now the bill would allow for same-day death.

I am wondering if the member is okay with the fact that in most cases it would allow for somebody to request being euthanized and have it happen on the same day.

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, depending on the track provided, there have been safeguards put in place so that the proper assessment can be done. Based on our consultations and experts' advice, I do not think a same-day assessment would be adequate, but again, I leave that to those individuals best suited to provide that advice. I leave it with the medical practitioners to make that assessment.

[Dan Mazier, Conservative, Dauphin—Swan River—Neepawa, MB]

Mr. Speaker, the member across the way mentioned rural Canada and access to doctors, and that certain doctors would review the 90-day circumstances for preconsent. What happens if someone cannot get access to that kind of doctor to prescribe on a particular disease on preconsent?

Is there any kind of leeway or language in the bill about that?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, that is certainly something that could also be brought up during the parliamentary review. What I was really referring to for individuals who live in remote areas was the number of witnesses required before their consent, which would be reduced to one, because of perhaps a smaller social circle or just not having as many individuals there. What you brought up could certainly be reviewed, and it should be.

[The Speaker, Liberal, Anthony Rota]

I want to remind hon. members to speak through the Chair and not directly to each other.

Questions and comments, the hon. member for Peace River—Westlock.

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Mr. Speaker, is the hon. member not concerned about the two classes of Canadians we could be building with this bill? Those who do not have an underlying condition and are suffering from mental illness are then eligible for all the suicide prevention tools of this country, but those with an underlying illness are not.

Is he not concerned this bill would be creating two classes of citizens?

[Gagan Sikand, Liberal, Mississauga—Streetsville, ON]

Mr. Speaker, I do not think this bill would create two classes of citizens. It would create two streams to make MAID available to them, as it should, because the circumstances are very different. I do not think it would create two classes of citizens, but would rightly create two different streams to make MAID available.

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, I rise today to speak to Bill C-7, which proposes to remove safeguards contained in the existing Criminal Code provisions for medical assistance in dying, as well as to expand eligibility. This is a grave matter and one that should not be treated lightly. Its impacts will be significant, especially for vulnerable Canadians. It is important that we get this right.

Before I get into the substantive issues contained in this bill, I would like to add my voice to those of the people who previously urged the Minister of Justice to appeal the Quebec Superior Court's ruling to the Supreme Court. One month after the Quebec Superior Court decision, 72 organizations that help Canadians with disabilities wrote to the minister, calling on him to appeal the decision. Less than a week later, 300 physicians signed a similar letter and since then, many others have voiced their concerns as well.

Referring it to the Supreme Court would have been the more prudent course of action, as it would have provided Parliament with a framework within which it could legislate. Alas, those many voices, as well as those of my Conservative colleagues in the House, went unheeded.

Further, when Parliament passed Bill C-14 in 2016, the legislation required a parliamentary review of its provisions to commence at the start of the fifth year following royal assent. That review, which was also to include a study of the state of palliative care in Canada, could have taken place this past summer but, instead, the government opted to shut down Parliament. That was time squandered.

There was much wisdom in including a mandatory review when Bill C-14 was adopted. Now, instead of giving this matter the thorough attention benefiting its gravity, parliamentarians are being asked to rush legislation through to meet the judicial deadline of December 18, unless, of course, a third extension is sought and granted. We call that putting the cart before the horse. It is therefore vital, in the short time we have to review these changes to the MAID clauses in the Criminal Code, that we hear from as many Canadians as possible from all walks of life, and especially those likely to be most impacted by any expansion of the current laws.

There are two changes to the existing law that are most troubling. The first is the repeal of the provision that requires that a person's natural death be reasonably foreseeable and its replacement with the words “grievous” and “irremediable”. The other is the elimination of the clause requiring a 10-day waiting period between when MAID is requested and when it can be administered. These changes need careful study. What will the unintended consequences be?

Moving forward, the priority of the Conservative Party is ensuring this type of legislation includes safeguards for the most vulnerable in our society, as well as for the conscience rights of physicians and all other health care professionals. One concern in that regard is ensuring adequate safeguards to protect those who may not have the ability to consent. Many of those involved in the care and advocacy for citizens with disabilities are sounding the alarm. We would be well advised to heed them.

I would like to quote from the letter from 72 advocacy groups written to the Minister of Justice just last fall. They were among those who urged the minister to appeal the Quebec Superior Court's decision in Truchon and Gladu. These are their words:

When the original medical assistance in dying legislation was debated in Parliament, there was a clear understanding that MAiD must have limits; that individual rights must be balanced with protections not only for our most vulnerable citizens, but for our society as well. One of the most important foundations of our Canadian identity is that we are a caring, compassionate country. We...place a high premium on being inclusive and tolerant while working hard toward the accommodation and integration of minority members of our communities. And yet, if the Quebec decision is allowed to stand [or as it stands now codified in the law], we will be in serious danger of losing this fundamental element of our Canadian identity. Our neighbours and our loved ones living with disabilities already continually experience the devaluation of their lives. They are frequently told—often bluntly—that they would be “better off dead.”

The letter makes the point that the unintended consequences would be to “...erode provincial health responsibilities for expert clinical care and social support of citizens who are fragile.”

It is crucial that adequate safeguards are included in Bill C-7, and that will be one of my highest priorities. Another concern worth repeating is removal of the end of life criterion. As the Council of Canadians with Disabilities stated in its October 2000 letter to the Minister of Justice, “Without the equalizing effect of the end of life criterion, which guarantees that the common thread between all persons who access an assisted death in Canada is that they are all dying,” with the proposed changes, “...persons with disabilities will be able to gain access ultimately because they have a disability.”

A worse stereotype could not be institutionalized in law: that disability-related suffering, largely caused by a lack of support and equality, justifies the termination of a person's life.

I now want to take some time to address the need for palliative care in Canada and the importance of such end of life care. As mentioned previously, a study of palliative care was to be included in a mandated parliamentary review. This should have happened before Parliament took action to expand the current Criminal Code provisions. Again, I would like to turn to the experts on this: the doctors and other health care professionals who provide end of life care and face these life-and-death decisions every day.

The Canadian Society of Palliative Care Physicians strongly advocates for the prioritization of adequate investment in, and enhancement of, palliative care services. Without access to high quality palliative care, some patients who are suffering may feel that MAID is their only option because their suffering has been inadequately addressed, or they perceive that their families or social supports must carry an excessive burden. Data regarding availability, access, quality and types of special palliative care, for example, are essential not only for those requesting or receiving MAID, but in general in order to better inform areas for improvement. Palliative care should remain distinct from MAID to ensure clarity, and to avoid risk of confusion and the potential for people to refuse palliative care services because they may confuse them with MAID.

During my consultations on Bill C-7, the doctors I have spoken with have stressed that palliative care is more than providing access to morphine, and that the public needs to be educated on this. As well, concern was expressed that elder abuse and financial motives, such as inheritance, could contribute to an abuse of MAID. Another concern is the temptation to save health care dollars with MAID. It is easy to conclude that MAID is more cost effective than continuing care. This raises ethical questions about its potential overuse, particularly as the previous safeguards are being lifted.

These are all serious concerns. I look forward to hearing what the doctors and health professionals on the front lines recommend as we move forward. I would also like to make a brief comment about the need for conscience protection for physicians. Doctors are concerned that they will be forced to administer MAID. I have been advised that the Ontario College of Physicians has created a policy that doctors have to arrange a referral. Some doctors have confided to me that they are considering leaving their profession over this. Suffice to say that physicians should have their freedom of conscience protected, and that this fundamental freedom needs to be codified in law as has been done in Australia.

In closing, I urge the House to take our responsibility to review this legislation seriously and to do as thorough a job as possible, keeping uppermost in mind those most affected by the decisions that we make. As those 300 physicians said in their letter to the Minister of Justice, “For all patients who seek an assisted death, we must ask first if they have had access to adequate and funded social and living supports, as well as exemplary health care and symptom management, in order to assure that they are not seeking an assisted death.” I think we can and must do better.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, in good part, I disagree with the member's assessment that we need to appeal to the Supreme Court of Canada or that somehow a lot of the discussion around the bill has not occurred. We have been discussing this virtually since the 2015 federal election. It has had all sorts of committees' direct and indirect input. Even this year, over 300,000 people participated through providing input. There has been an enormous amount of consultation. A lot of that never ended after we first passed the legislation.

What we see before us are some changes that we learned from, whether it was a court order or from what Canadians have been saying for the last while.

Does the member not agree that it is time, at the very least, to allow it to go to committee where we can get additional feedback on some of the specifics that have been raised here in second reading?

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, I guess I would say two things.

First, if the government had not prorogued Parliament, we would have had a whole summer to have more of these discussions.

Second, much more discussion needs to happen. I will tell colleagues exactly why.

This past Friday, I spoke to two doctors via Zoom. They are the ones who specifically told me four points: They are considering leaving the profession. We cannot afford to lose any more physicians. They were taught to save lives, not to take them away. What a powerful statement. The doctors told me that 800 physicians have signed a new letter denouncing them from being forced to refer a patient to another doctor to get MAID, and that more would sign that letter, but they were afraid that the hospitals would blackball them and they were in fear of losing hospital privileges.

Much more discussion has to happen over this and it will definitely be going to committee. I look forward to it.

[Kristina Michaud, Bloc, Avignon—La Mitis—Matane—Matapédia, QC]

Mr. Speaker, I thank my colleague for his speech.

He mentioned the December 18 deadline and seemed worried that we are moving too fast with this bill, but in my opinion, the government has already asked the courts for enough extensions.

Does my colleague agree that the reasonably foreseeable death criterion was too restrictive and that we have to stop postponing the dignity of seniors and seriously ill individuals? Does he agree that we need to send this bill to committee quickly so that it can be studied and passed in response to the Quebec Superior Court's decision?

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, definitely more discussion needs to happen at committee. There is no doubt. I will continue going back to our parents, doctors and clergy as more discussion has to happen around them as well. I am really concerned about them being victimized. For them to not be able to speak with their conscience and to be forced to not discuss life and death is a real issue.

As I mentioned before, doctors do not lie. Doctors told me on Friday about the shortcomings in this bill, and that is why I am looking forward to getting Bill C-7 to committee, fixing it and amending it as required.

[Tracy Gray, Conservative, Kelowna—Lake Country, BC]

Mr. Speaker, I would like to thank my colleague from Essex. You had mentioned palliative care. I wanted to ask you this, especially at a time when families are separated due to COVID-19 and people are feeling isolated. We see palliative care as an important part of the health care service, and it is not readily available to everyone.

I am wondering if you could maybe expand on that.

[The Speaker, Liberal, Anthony Rota]

The hon. member for Essex, in 25 seconds or less.

I just want to remind the hon. members that even though we are close and it is very intimate, to please place your questions through the chair. Thank you.

The hon. member for Essex.

[Chris Lewis, Conservative, Essex, ON]

Mr. Speaker, palliative care is very near and dear to my heart. Caregivers did a wonderful job when my mémé had brain cancer and kept her incredibly comfortable. The discussion within our family was not about how to end her life; it was about how to make it more comfortable and last a little longer, so palliative care is vital.

[The Speaker, Liberal, Anthony Rota]

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Kelowna—Lake Country, Indigenous Affairs; the hon. member for Mission—Matsqui—Fraser Canyon, Health.

Resuming debate. The hon. member for Cypress Hills—Grasslands.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Mr. Speaker, before getting into the details of the proposed legislation in front of us, I first want to make sure that in the House we avoid a common misunderstanding that seems to come up whenever people strongly disagree with assisted suicide or related issues. Quite often, someone in favour of allowing assisted suicide or removing safeguards will express compassion and empathy for those who are suffering. In saying this, I am not questioning their feelings or their sincerity; nobody wants to suffer or watch their loved ones go through terrible pain. What I am saying here, for everyone's benefit, is that those who are opposed to it or who want to support safeguards have a deep sense of compassion and empathy for those who are suffering. In other words, our human feelings of compassion by themselves do not automatically lead to one position or another.

Along with my wife, I have watched four grandparents pass away, and at present we have another one who is living in palliative care. Each time I have witnessed and cared for family members as they go through difficult health problems, I am reminded of the importance of always affirming a dying person's dignity while they live out the last part of their life.

For the past year, we have had widespread awareness of and concern for how the spread of COVID-19 could devastate seniors and others who are more vulnerable because of medical conditions. For the most part, these are the same people who are at risk and would be even more so under this new law. Along with everything else we could learn from 2020, I hope we can improve our medical practices and strengthen safeguards for the most vulnerable in every area, including this one.

As we continue to debate Bill C-7, it is important for all of us to take a moment to carefully consider its wider impact and unintended consequences. If passed, the new law will significantly expand the number of Canadians who will be eligible for assisted suicide. Whether we agree with these changes or not, it is clear that they are major and fundamental.

It was only a few years ago that Parliament passed Bill C-14, which created the legal framework for what it called “medical assistance in dying”. Previously, the Criminal Code had considered it a serious crime to either kill a patient or participate in a patient's suicide. While amending the section on culpable homicide and defining eligibility, it presented MAID as the narrow exception.

At the time, the former justice minister, with the same sense of transparency for which she later fell out of favour with the Liberal government, publicly stated, “We recognize that medical assistance in dying will in many respects fundamentally change our medical culture and our society.” It was true for what happened back then, and now we are adding some more major changes before the last ones were ever properly reviewed. There was supposed to be an official review of the MAID system, but that has not happened.

Without having a thorough and careful review, we are supposed to proceed with Bill C-7 anyway. So far, in the current session, we have started debating this bill for part of only four days. I hope there will be much more time than this for considering this bill at every stage, especially when it is studied by the justice committee. There is so much that should be said, and the amount of time we all have to work with is too limited.

I share the deep concern of many Canadians who recognize that this bill undermines our country's commitment to upholding and protecting the equal value of each human life. More particularly, there needs to be even more attention given to how assisted suicide, especially in the way this bill handles it, affects the lives and social well-being of people with disabilities.

Over the past year, the idea of systemic discrimination has come to the forefront of our public discourse in Canada, in the U.S. and around the world. To help us better reflect on how it can relate to this discussion, we can look to the work of Dr. Laverne Jacobs. Dr. Jacobs is a law professor at the University of Windsor. She has approached the issue with her legal expertise and speaks from her experience as a Black woman living with disabilities in Canada.

As part of a longer presentation about MAID back in January, she compared and related the experiences of minority communities. She said, “What's particularly troubling about any system or any structure of systemic discrimination is that once ideas that are harmful to a minority group have been legislated into law, it is very difficult to convince the general public that they are not stigma-inducing or ultimately discriminatory. So in both cases, in both the case of racial inequality in the U.S. and the case of MAID here in Canada, we're dealing with the stigmatization of a historically disadvantaged group.”

In an article on the subject of MAID, Dr. Jacobs wrote:

More explicitly, while the MAID law indeed requires consent, these irreversible choices about ending a life are made in a complex social, cultural and health-care context, where lack of access to adequate care, lack of social support and overall ableist stigma have an impact on the choices people with disabilities may have.

In the same article, she also said:

There are also concerns, fuelled by developments in the few countries that provide access to MAID outside the end-of-life context, that being elderly and fragile is increasingly accepted as a reason for a physician-assisted death and that this may create subtle pressure.

This is a small sample of her work, and Parliament would do well to take a closer look at the rest of her comments.

Loss, especially one of this nature, directs and shapes people's actions and attitudes. We cannot say that people with disabilities and other vulnerable populations have not told us this and explained how this bill will inevitably hurt them. Many other advocates and members of the disability community have been speaking out with similar fears, but they were not heard when they called for the government to appeal the Quebec Superior Court ruling. They have also been ignored when it comes to the problems in Bill C-7.

Bill C-7 has to do with life and death, which are ultimate realities. It is reasonable to expect that altering the way our institutions and culture approach the most consequential matters will have wide-ranging effects across all of society. It is hard, if not impossible, to imagine where we will end up if we follow this path.

In my remaining time, I want to highlight some of these problems.

Most notably, Bill C-7 removes the reasonably foreseeable natural death criterion, which is very concerning to me. I am concerned that removing it will normalize suicide over time. Without appealing the decision, the government is going beyond what the Quebec Superior Court ruled.

As one example, the government wants to allow for advance directives. As I have said before, there has been no thorough review of MAID as it currently operates. I am also not aware of any specific study about the risks and problems associated with a process for advance directives. That should happen well before we ever consider enacting it.

Advance requests raise difficult questions. For example, I have to wonder: Could someone consent in advance to be killed once they reach a state they fear but have never experienced, like living with advanced dementia? Further, once someone has signed an advance request and lost the capacity to consent to medical treatment, at what point exactly would their life be terminated? More alarming to me is this: If a non-capable person seems to resist a lethal injection, can the physician still proceed with the injection if the physician believes that the resistance is not due to any understanding on the patients's part that the injection will kill them? Bill C-7 states that apparent resistance means a doctor must not proceed but clarifies that involuntary responses to contact is not resistance. This raises another question. How does a doctor determine if the response to contact is involuntary?

Given that advance requests raise serious ethical issues, oversight challenges and safety risks, legalizing advance directives in the way that Bill C-7 would is irresponsible. This is the position we are left with when we are not trying to create effective accountability mechanisms and when we have insufficient data.

I am also troubled that Bill C-7 would remove the 10-day waiting period. Frankly, I find this disturbing. The 10-day waiting period in Bill C-14 already had a built-in exemption for those whose death or loss of capacity to consent was imminent, and as such, I cannot understand why the removal of this waiting period is necessary or prudent. On the contrary, I find it negligent.

It is well established that the desire to die is often transient. Suffering individuals have ups and downs throughout the day, throughout the week and throughout the year. No one should be able to make a death or life decision when at their most vulnerable point. The 10-day waiting period effectively allows a patient to reconsider their decision and take the time to speak with loved ones. This is critical.

Finally, I want to add that I believe the bill should add a provision that prohibits medical practitioners from discussing MAID unless the patient explicitly asks. We must not underestimate the power of pressure and suggestion, no matter how subtle, especially when it is combined with social stigma, as I mentioned before.

Journalist Ben Mattlin, who suffers from spinal muscular atrophy, wrote this in the New York Times:

I’ve lived so close to death for so long that I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless—to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

Perhaps, as advocates contend, you can’t understand why anyone would push for assisted-suicide legislation until you’ve seen a loved one suffer. But you also can’t truly conceive of the many subtle forces—invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami—that emerge when your physical autonomy is hopelessly compromised.

Despite Mattlin's significant physical disability, he is a father, husband, author and journalist. He has a successful life and knows what he wants. He is less vulnerable than others who might be more easily persuaded that MAID is their best option. In this way, voluntary MAID is the start of a slippery slope that leads to involuntary MAID.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, all lives are of equal importance. I listened to the member across the way, and I think he is ruling out what, I believe, a vast majority of Canadians want.

I recall the debates we had in 2016 when, in essence, we were talking about this issue in a tangible way for the first time on the floor of the House of Commons. Through that debate, we ultimately saw good legislation, but I believe everyone back then realized there would be a necessity for change.

There have been ongoing discussions. All sorts of consultations have taken place at a multitude of levels. I think we have something before us today that will make the legislation better overall, and the member will be afforded an opportunity to hear and provide more feedback.

Does the member have any specific amendments he would like to see in the legislation before us today?