Debates of Oct. 9th, 2020

Criminal Code

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I will clarify that it is in a fourth place as well. It is in the penultimate paragraph of the Carter decision.

The reason the government is not intervening in respect to a jurisprudential decision in Ontario is because that jurisprudential decision complies with the charter. The regime in Ontario is that a person is not compelled to provide this service, as the court has indicated, but providing a referral is required, pursuant to the rules enacted by the College of Physicians and Surgeons of Ontario. That was deemed constitutionally compliant. That is sufficient for the purposes of protecting the Charter of Rights at issue.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Madam Speaker, I want to thank my colleague for his speech. I appreciated his knowledge on the topic and his compassion in all this. It is very important.

The Bloc Québécois supports the bill in principle, as my colleague said earlier. I appreciate the fact that we can work together in a non-partisan way.

However, we believe that the bill may not go far enough in certain respects.

Does my colleague believe that the issue of advance consent should have been covered in this bill?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I thank my colleague for this question and thank the Bloc Québécois for its support.

The notion of advance consent was put into this bill because it was necessary to accommodate Audrey Parker's request, which was covered extensively by Canadian media.

We must maintain an individual's autonomy and respect their choice, but also avoid prolonging their suffering or making a decision that would lead to premature death.

In English terms, it is the notion of not having someone accelerate and go to their death prematurely, simply because they had to wait for the ability to provide that final consent. That is the reason why we decided to insert it as consenting to the regime.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, first, we are pleased to see the reintroduction of Bill C-7 as part of the effort to end unnecessary suffering for those who are facing the end of life. I had a note from Jule Briese. She cited that her husband, Wayne, who is challenged with Alzheimer's, currently meets the criteria for medical assistance in dying as long as his window of capacity for informed consent does not narrow, preventing this. He has ongoing appointments at three-month intervals with his geriatric psychiatrist to assess his capacity for consent. She cites that this is extremely stressful, and could result in having to make this choice sooner rather than later. Legalizing advance requests for those with dementia to make the choice for MAID compassionately supports the individual's right to end-of-life choice guaranteed by the Canadian Charter of Rights and Freedoms.

Could the parliamentary secretary speak to Julie and Wayne, and talk about how this legislation is going to help them? We certainly do not want him to have to choose to end his life prematurely, and this is a directive he would like to have fixed in the bill.

[Arif Virani, Liberal, Parkdale—High Park, ON]

Madam Speaker, I thank the member for this point and the case he is raising about Julie and her spouse. It underscores the very sensitive and delicate nature of what we are facing. What I can say in all candour is that we had a regime that had been deemed overly restrictive by courts. We have expanded the regime to allow for greater accessibility to medical assistance in dying. The notion of an advance consent is applicable here, but not yet an advance directive. That is something that was studied by the academic council when it looked at three separate areas. It would form part of the parliamentary review, and it is something that merits scrutiny. The safeguards that need to be put in place are that much more rigorous. That is why it is not inserted into this bill, but is something that obviously merits a lot of scrutiny and consideration going forward.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, before I begin, I want to wish you a happy Thanksgiving.

I appreciate this opportunity to discuss the Government of Canada's consultation process to inform amendments to the federal legislation on medical assistance in dying. My colleagues who hosted the round tables, the Minister of Justice, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, had the privilege of hearing the perspectives of experts and other key stakeholders.

In September of last year, the Superior Court of Quebec handed down its decision in the Truchon and Gladu case.

The court found that the eligibility criteria of the federal and Quebec provincial legislation on medical assistance in dying that required a person to be at the point of reasonable foreseeable natural death, or at the end of life, were unconstitutional.

The federal government did not appeal the Truchon decision. Despite the short time frame, our government felt it was critical that any amendments to the law should be informed by evidence and feedback provided by Canadians, provincial and territorial governments, and key stakeholders.

That is why, during January and early February, our government launched an online public consultation and hosted round tables with stakeholders from across the country. During this process, participants shared their views on key aspects of the law governing MAID, including eligibility requirements, safeguards and advance requests. An online survey led by the Department of Justice ran for two weeks in January. The survey closed with over 300,000 responses: the largest number of responses the department has ever seen for any public consultation.

Our government also hosted a series of 10 roundtable meetings in eight cities across the country. More than one hundred participants representing nearly every province attended these national and regional meetings, including academic experts, health care providers, medical and nursing regulators and other stakeholders. While the meetings included some representation from indigenous communities, a specific roundtable was also held with indigenous stakeholders.

Our government’s ultimate objective is to have a law that facilitates access for those who are eligible for MAID, and provides protections for vulnerable people.

Feedback from both the online survey and round table discussions indicated wide support for removing the eligibility requirement that an individual's natural death be reasonably foreseeable. There is general comfort among Canadians and stakeholders with the idea that MAID should be available to eligible individuals who are suffering intolerably, but not necessarily at the end of their life.

Many organizations representing persons with disabilities expressed concerns about the removal of the requirement for reasonably foreseeable natural death, pointing to the potential for societal harm if disability were to be seen as a reason to terminate life.

Concerns were raised about extending MAID to include specific medical conditions where individuals may be more vulnerable, in particular, to those with mental illness. Most felt it was too early to allow MAID for persons with mental illness as their sole underlying medical condition and advocated taking additional time to study this issue.

The concerns about access to medically assisted death for individuals whose sole underlying medical condition was a mental illness were consistent with the findings of the Council of Canadian Academies report on this topic. As mandated by the 2016 legislation, our government commissioned three independent reviews on topics that were not included in the law at the time: requests by mature minors, advance requests and requests where a mental illness is the sole underlying condition. Of the council's three reports, the one addressing mental illness was the source of the greatest divergence among the experts. Ultimately, they could not reach consensus on ways to address the complexities and mitigate the risk associated with mental illness and MAID.

Many round table participants expressed support for creating a two-track system of safeguards, depending on whether a person's death is reasonably foreseeable. Many respondents to the online survey were open to the idea of some stronger safeguards for people who are suffering but not dying.

The proposed legislative changes include new or modified safeguards for individuals when their death is not reasonably foreseeable. It is proposed that one of the physicians or nurse practitioners assessing an individual's eligibility for MAID would need to have expertise in the individual's medical condition. In addition, individuals would be subject to a 90-day assessment period to ensure enough time is devoted to exploring relevant aspects of the person’s situation and to discussing possible options to alleviate their suffering.

During the round tables, participants expressed overwhelming support for removing the current requirement for two persons to witness an individual's MAID request. They cited the difficulties in finding independent witnesses based on the current definition in the law, which excludes health care providers and personal support workers.

Many individuals living in nursing homes or other residential settings have limited family or social networks. The amended legislation would reduce the required number of witnesses to one, and would not permit individuals who are paid to provide personal care or health care to take on this role. Anyone in a position to benefit financially, or in any material way, from the person's death would not be allowed to act as a witness.

The witness's role is strictly to confirm that the person seeking MAID has actually signed the request themselves. Safeguards, such as ensuring that the person signed the request voluntarily, are the responsibility of the practitioner who provides MAID, not the witness. We also clearly heard that there is no obvious benefit to the 10-day reflection period. We are proposing to remove this requirement from the legislation.

The third area of consultation was on the issue of advance requests. This is also one of the topics studied by the Council of Canadian Academies as part of their independent reviews.

Although many people speak of advance requests in general terms, the issue can be very different depending on an individual's situation relative to a diagnosis and when they are eligible for MAID.

The CCA report pointed out that not all advance requests are created equal and outlined several scenarios. It noted the most straightforward scenario is where an individual is nearing death, and has been found eligible for MAID, but fears losing capacity to consent prior to the procedure.

This was the case, for example, in the widely publicized case of Audrey Parker: the Nova Scotia woman battling late-stage breast cancer. She feared that she would lose the ability to provide consent later on, before the date she ideally wished to have the medically assisted death she was authorized to receive.

A more complicated scenario arises when an individual has been diagnosed with a disease such as Alzheimer's, but has not yet come to the point where their circumstances make them eligible for MAID. However, the person may wish to outline the conditions under which they would like MAID to be provided in the future, when they no longer have capacity to provide final consent.

Nearly 80% of respondents to the online survey agreed that the revised law should allow for advance requests in both scenarios. However, there were concerns about allowing advance requests post-diagnosis. There was near unanimous support to refer this more complex scenario to consideration during the parliamentary review process.

The amendments we are proposing reflect the overwhelming support for the first scenario by permitting individuals who have been assessed as eligible for MAID, and whose death is reasonably foreseeable, to provide consent in advance if they lose capacity before their preferred date.

Our government is committed to maintaining an ongoing dialogue with indigenous groups on the topic of MAID, to ensure their families and their many diverse voices continue to be heard.

Lastly, it is important to note that, across the board, participants in the round table consultations all agreed on the importance of having appropriate health and social supports in place, including palliative care, assistance for persons with disabilities and mental health services, to protect against individuals choosing assisted dying due to the lack of adequate supports to live a dignified life.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, my question for my friend from Glengarry—Prescott—Russell is with respect to advance consent. The legislation provides for advance consent in certain circumstances in which a patient might lose their capacity.

When we studied the issue of advance consent under Bill C-14, the Canadian Medical Association noted that it was an extremely complex area. The expert panel's final report from the Council of Canadian Academies noted that there are significant knowledge gaps and a lack of consensus with respect to administering euthanasia, or medical assistance in dying, when a patient has lost capacity.

Why would the government include that in this bill, rather than allow a more thorough legislative review to take place, which it has pre-empted?

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I certainly was not a member of the justice committee, but I do believe the rationale for including the advance consent in this particular case was because of the Audrey Parker case in Nova Scotia.

I can also say that the Canadian Medical Association, I believe, is supporting this particular legislation in accordance with what we are presenting today.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, as I know from his frequent interventions at the agriculture committee, the member for Glengarry—Prescott—Russell proudly represents a rural riding. My question is centred on that very fact.

As the member knows, the new second track for accessing medical assistance in dying requires that one of the two medical practitioners assessing the person has expertise in the condition from which the person is suffering.

How is this going to play out for Canadians who live in rural or remote areas, and who may not have access to that kind of expertise? How can we ensure that the provisions of this bill make sure that Canadians, regardless of where they live, have access to that kind of expertise?

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, the previous bill required two witnesses and this bill only requires one witness. This was actually raised with the Minister of Justice. I believe this will correct the issues that arose from the previous bill, Bill C-14. The current bill strikes the right balance to make sure there is access to a doctor or nurse who has knowledge of the particular patients in question.

[Mario Beaulieu, Bloc, La Pointe-de-l'Île, QC]

Madam Speaker, I would like my colleague to comment on the possibility of granting the right to waive final consent when natural death is not foreseeable.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, quite frankly, I have no opinion on the matter and will therefore rely on the experts.

I know the Bloc Québécois and the NDP support the bill. The Standing Committee on Justice and Human Rights will have an opportunity to examine this more thoroughly in the coming weeks.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, my question for the hon. member has to do with the cool-off period, the 10-day provision that was previously there. It was to address, as I recall, when people are seriously ill and suffering. They can be depressed. One day they feel great and the next day they do not. That is why the 10-day period was put in. I am not sure what the rationale was for taking this out. Perhaps the member could comment on that.

[Francis Drouin, Liberal, Glengarry—Prescott—Russell, ON]

Madam Speaker, I believe it was taken out because, in terms of practicality, it served no purpose. The Minister of Justice and many of our colleagues heard from families, now that we have been living with Bill C-14 for over three years, about the 10-day period. Patients who have already made the decision that they need medical assistance consulted with their doctors, nurses and families about that extra 10-day period. Why is not 15 days? Why is it not five days instead of 10? They said it served no purpose.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I will be splitting my time with the member for Sarnia—Lambton.

It is my pleasure as shadow minister for justice for the official opposition to use this opportunity to speak to the proposed legislation before us. It is important legislation. We have been hearing points from both sides of the House on Bill C-7, which impacts many Canadians. In fact, it impacts us all. This is a piece of legislation that deals with life and death, and there is probably nothing more important that we could be talking about today.

Any time we, as legislators, are asked to review and analyze legislation like this, it is critical that we take the time to get it right, and this is part of the problem. As we have heard many times over the course of the last year, we should not be dealing with this legislation today because the Minister of Justice and this government should have appealed that decision.

This is what was being called for by those in the medical community, those in the disability community and individuals across the country after that decision came out in Quebec. The right thing to do, which is what our party, the Conservative Party, called on the government to do, would have been to appeal that decision.

What we have been left with is a patchwork across our country. We have been left with confusion. We should have had the certainty of an appeal to the Supreme Court of Canada on something this important. Instead, the government took the Superior Court of Quebec decision, responded to it and, in my view, went far beyond what was required to respond to that decision. I will discuss some of those things.

The bill was introduced as a response to a Superior Court of Quebec decision made on September 11, 2019. That decision found that the law was too restrictive in the requirement for death to be reasonably foreseeable in order to access medical assistance in dying. At the time, we called upon the government to appeal this decision to the Supreme Court.

As we debate the bill before us, we still do not have the clarity that we could have had if the government had appealed that decision. Rather than defend its own legislation, this government has used this as an opportunity to broaden assistance in dying legislation in this country without doing the fundamental consultation and homework necessary to get an important decision like this right. Even in the previous legislation, Bill C-14, there was to be a mandatory review of assistance in dying legislation and what flowed from it, which was to take place this past summer. This government circumvented all of that with this new legislation.

When the government passed Bill C-14 in the 42nd Parliament, it required this review to be conducted this year. The review was to analyze the state of assistance in dying in Canada in a comprehensive way, and instead of waiting for that, we see with this legislation the government going far beyond what had to be done to respond to the Quebec court decision.

This topic is a very sensitive issue for many in the House who have personal experience with it and, indeed, it is a sensitive issue for many Canadians. We ask that all members on each side of the House be aware of this. While there may be disagreements, we are each here to represent our constituents and arrive at legislation that best protects Canadians.

I have heard directly from many Canadians who are concerned about the lack of protection for conscience rights for health care professionals in both the bill before us and the original MAID legislation. As the government looks to broaden the legislation further, it becomes even more important that the conscience rights of health care professionals are protected. By further expanding medical assistance in dying, the government risks reducing the number of medical professionals willing to take part in this process. It is also important to note that this expanded access could result in a heavy emotional burden on those health care providers, as we head into uncharted territory with the bill.

We, as members of Parliament, cannot appreciate the burden that this has put on health care providers who are working in this system and providing medical assistance in dying.

Further, there are very few protections in place for medical professionals who do not want to participate in the process and may be penalized, as a result, by an employer. This is a point that I raised when Bill C-7 was introduced earlier this year, and it is disappointing to see that it was not corrected in this version of the bill.

This brings me to my next point about standing up for Canadians with disabilities. The 10-day waiting period, which could already be waived in the legislation for extenuating circumstances, has been removed. I heard the chief justice say today that removing the 10-day waiting period was universally accepted in his consultations across the country. I wonder who he has been talking to.

Yesterday I spoke with a group that represents those with disabilities across the country at Inclusion Canada. Those in that group said that they are in favour of maintaining the 10-day waiting period, and their role is to stand up for individuals with disabilities. It is interesting to note that they called on the minister of justice at the time to appeal the decision of the Quebec court. They said that medical assistance in dying must have limits. Individual rights must be balanced with protections, not only for our most vulnerable citizens, but also for society as well.

One of the most important foundations of our Canadian society and identity is that we are a caring, compassionate country. For those with disabilities, their experience now is that they are told, often bluntly, that they would be better off dead. The Foley case in London, Ontario, is one example of this. This decision, if it remains unquestioned, will simply erode provincial health responsibilities for expert clinical care and social support for people who are fragile.

The Minister of Justice would also be familiar with a letter written to him on October 4, 2019, which was signed by over 70 organizations that stand up for Canadians with disabilities from coast to coast to coast. They wrote that they found the decision by the Superior Court of Quebec to be very concerning. One of the reasons for this concern was that the decision failed to respect Parliament's authority to balance the interests of the individuals with the interests of society, effectively limiting Parliament's capacity to pursue social targets, such as substantive equality and inclusion.

They describe the decision as a dangerous precedent, writing, “The Supreme Court must weigh in on this flawed analysis. The decision will entrench stereotypes and exacerbate stigma further for Canadians with disabilities.” The letter continues, and I agree, “[We] must avoid sending a message that having a disability is a fate worse than death.... Canada must appeal the decision to prevent additional stereotyping”. The letter concluded by urging the government to appeal the decision to the Supreme Court.

Again, the letter was signed by over 70 organizations, including the Council for Canadians with Disabilities, the Canadian Association for Community Living, Disability Law Centre, People First of Canada and the Canadian Mental Health Association. I mention this because it underscores how we need to get this legislation right.

Last November, the Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians issued a call to action due to ongoing confusion in the general public regarding hospice, palliative care and MAID. Quite frankly, palliative care focuses on improving the quality of life and symptoms through a person-centred approach for those living with life-threatening conditions.

The federal government should be looking for ways to improve further palliative care across Canada, as was committed to many times by the government. In their call to action, the groups I mentioned state, “Less than 30% of Canadians have access to high quality hospice palliative care, yet more than 90% of all deaths in Canada would benefit from it.”

I want to stress my previous point that this is an important issue for many Canadians. On matters of literal life or death, we need to take our responsibilities as legislators—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Questions and comments, the hon. Parliamentary Secretary to the Minister of Justice and Attorney General of Canada.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I thank the hon. member opposite, the official opposition critic, for his work at the committee and his work today in the chamber.

As an observation, it seems some parties opposite feel we are either taking this too far, as expressed by the official opposition, or not taking it far enough, for example, by entertaining advance directives. Clearly the proposal before the House is one that is a middle approach, a prudent approach and one that is constitutionally compliant.

The points raised about the disability community are well taken. Those are important points, and the minister addressed these points about the importance of equality and supports for those with disabilities. That is exactly what the consultations revealed.

The member opposite used the phrase “without doing consultations”. The evidence shows, and this is available on the Department of Justice website, that we heard from 300,000 Canadians, had 125 experts and ten meetings around the country. Is that kind of consultative exercise exactly the type the member has asked us to undertake?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank hon. parliamentary secretary for his work on the justice committee and on this file.

It is one thing to consult, but it is another thing to listen and hear what people are saying. We are hearing, loud and clear, from those in the disabilities community that this legislation, and these are their words, not mine, leads us to a society that says their disabilities are a fate worse than death. They want to see more protections in the legislation.

The hon. parliamentary secretary or the minister could pick up the phone and speak with Inclusion Canada or any one of the 70 signatories to that letter to hear about what they would like to see included in legislation safeguards to protect the most vulnerable in our society.

[Christine Normandin, Bloc, Saint-Jean, QC]

Mr. Speaker, I thank my colleague for his speech. I heard him mention that the government should have appealed the ruling and that, practically speaking, parliamentarians are somewhat muzzled by the courts.

He makes it sound like medical assistance in dying is going to be imposed on people with disabilities, whereas, in my view, this is more about a patient-centred approach. This is about giving patients options, not imposing anything.

I would like to hear my colleague's thoughts on what I just said. Did I misunderstand him? Does he not think it is more coercive to deny patients this right? Does he really think anyone wants to impose medical assistance in dying on people who could ultimately have a choice?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, normally with a case like this, which comes from one province's courts, a case of national importance, the responsible thing to do for certainty, because we are a federation, would be to appeal the decision to a higher court and, indeed, on a decision this important that impacts our criminal law would be to appeal the decision to the Supreme Court of Canada.

We are listening to organizations that represent those with disabilities. They say that the failure to appeal the decision, the failure to pre-empt the study that was to take place this summer on assistance in dying legislation and the desire of the government to push something out right after there was one decision on it, pushing new legislation that goes beyond what the decision called for, is an affront to those persons with disabilities.

We are listening to them, and those are their words on this bill.

[Marc Dalton, Conservative, Pitt Meadows—Maple Ridge, BC]

Madam Speaker, this being Mental Health Week, could the member comment on the challenges people are facing in our nation right now? This year one in five are suffering from mental health issues.

What are the implications of this new legislation for people with mental health issues?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank the hon. member for the reminder to all of us that it is Mental Health Week.

We are hearing from those who suffer from mental health issues, from those in the disability community and from a broad range of people. This legislation literally deals with life or death. As the member rightly pointed out, as we have seen over the last several months with the COVID-19 crisis, mental health issues have been brought to the forefront. We need to ensure that even—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

Resuming debate, the hon. member for Sarnia—Lambton.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I am happy to have the opportunity to rise today to speak to Bill C-7. It is a very serious matter. As the member for Fundy Royal just mentioned, it is a matter of life and death. I was part of the debate on the original bill, Bill C-14, and I am familiar with a number of the issues with that bill.

It is very disturbing to me. I understand with the Quebec court decision the government had to make a response of some sort, but the previous bill required them to do a fulsome parliamentary review, which was supposed to take effect this past summer. The government refused to let Parliament sit this summer and do the kind of fulsome work that needed to be done.

It is actually quite irresponsible that when the government introduced Bill C-7, instead of just addressing what was time sensitive in responding to the Quebec decision, it went further and took actions without doing that fulsome review of how things have been going with Bill C-14 in the last number of years.

For those watching at home who are not familiar with Bill C-7, the bill would repeal the provision that requires a person's death to be reasonably foreseeable. In addition to that, it would specify that people whose sole underlying condition is mental illness are not eligible for medical assistance in dying. It would create two sets of safeguards that have to be respected before medical assistance in dying can be provided to a person, and it would permit medical assistance in dying to be provided to a person who has been found eligible to receive it and whose death is reasonably foreseeable but who has lost the capacity to consent before the medical assistance in dying is provided. That is sort of an advance consent, and we will talk a bit more about that.

Bill C-14 was not without some issues that were not addressed in the previous legislation and will probably be considered in the fulsome review. There was a question about whether minors should be able to receive medical assistance in dying. There was significant discussion about advance consent. A lot of Canadians were demanding it, and I will talk a bit about some of the considerations that may have kept the government from moving ahead at that time. There was discussion of those who are not mentally competent to give consent. There have been a number of speeches today mentioning people with dementia, for example. That is another area where there was work done by the Council of Canadian Academies, the CCA. It did fulsome reports on a number of these things, and I will talk a bit about what was found.

There was discussion today about the protection of conscience rights, and I do not agree necessarily with the Parliamentary Secretary to the Minister of Justice. I see the charter provisions that were put into Bill C-14, but forcing somebody to refer, when they do not want to have anything to do with the process at all, is actually violating their rights. I am not a fan of violating one person's rights to give another person their rights. That is not good, so we need to have more discussion about that.

In its report, the special committee that studied the Carter decision said that, without good-quality palliative care, people really cannot make a true decision. They really do not have a choice. Obviously I have been an advocate for palliative care. My private member's bill, Bill C-277, on palliative care, was unanimously passed in the House and in the Senate. The government did a good job of putting the framework in place to get consistent access for all Canadians to palliative care.

The problem is that, once the framework was in, the government has since really not pushed ahead. There are 70% of Canadians who have no access to good-quality palliative care. Especially in the time of COVID, where people are dying, it is becoming even more important. The government needs to take action to up its game on palliative care to make it more available to Canadians.

There is an opportunity and a responsibility for the government to show leadership in how palliative care is being implemented in Canada. Right now, for example, British Columbia is violating the World Health Organization's requirements for where MAID should be performed. It has specifically said that palliative care is a different thing from medical assistance in dying and that they should not be performed at the same location because of a tendency by people wanting palliative care to be afraid that they will accidentally receive medical assistance in dying against their wishes. There is an opportunity for the government to revisit that and I am hopeful that it will.

With respect to the Council of Canadian Academies, many issues were studied. On the advance directives and advance consent issue, we see in this legislation that the government is allowing people who believe their conditions are going to decline and are eligible to receive medical assistance in dying to have a 90-day advance consent. It is not clear to me in the legislation when the 90 days start. Is it when patients first have discussions with their physicians? When does the clock start? That is a clarification that is needed in the legislation.

When the council looked at advance directives, it said there were a few difficulties. The first one was how to prove people have informed consent, what the criteria are and what the definition is of that. Therefore, that would have to be addressed. Who decides what is intolerable suffering, especially if the person has lost capacity? That is another question that needs to be and should be considered in this fulsome review that is required and that I would have preferred to have had before this bill came forward.

As a point of information, Belgium and Luxembourg only allow an advance directive when a person is permanently unconscious. That is the only way they will allow a person to have an advance directive in place: If they become permanently unconscious, they will receive medical assistance in dying.

On the issue of minors, “mature minors” would have to be defined. In Quebec, that is defined as people aged 14 to 17. However, we have to make sure they have the capacity to make medical decisions and confirm they understand that it is voluntary and they are not under duress. There are not many jurisdictions that have extended this to mature minors. The Netherlands does allow people aged 12 to 16, with parental permission, to have medical assistance in dying, and those aged 16 to 18 with parental consultation. Belgium allows it if the person is terminal, but pediatric palliative care has to be provided as an option. Therefore, there needs to be further discussion on that one.

Then there are those who suffer from mental illness. I was very pleased to see that it is clear in this legislation that they would not be eligible. It was very controversial. The council that studied it could not agree. There was discussion about the capability for informed consent and the fact that people with depression could have good and bad days and may change their minds, which again points to the need for some kind of cooling-off period. The Netherlands allows this but for dementia only, and there is still a lot of controversy about that.

The safeguards that were in the bill originally seem to have been removed. I am not a fan of doing that because I would say that if we remove the conditions that have to be met in order to get something, more people will take advantage of it. I am concerned with a broader creep on this, but I am sure there will be fulsome discussion about this at committee.

In Canada, everyone has the freedom to express themselves, to believe what they want and to choose what they want, and we should treat everyone's individual choices with respect.

[Arif Virani, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I know the member for Sarnia—Lambton as an advocate of science and palliative care, which she raised today and is an important point. The question I would put to her is an observation about the current state of palliative care in Canada.

The government has invested $11 billion in accommodation of home care and mental illness care, which includes targeted money directly for palliative care. It is not just supplying the programming but ensuring that palliative care is provided to those seeking MAID. That is in track two, where someone's death is not reasonably foreseeable. The new requirements are that a person must be informed of counselling, mental health supports, disability supports and palliative care. Further, the practitioner must agree with the person that they have discussed and appropriately considered receiving means of alleviating their suffering before anything can be acted upon.

I know the member has talked about safeguards throughout today's debate. Do those address some of her important concerns about palliative care?