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.