House of Commons Hansard #13 of the 43rd Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was medical.

Topics

Criminal CodeGovernment Orders

2:10 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Madam Speaker, these are absolutely the kinds of supports that are needed, but the reality is that they are not actually in place everywhere. This makes a huge difference.

I will give an example from the first year after Bill C-14 came into law. Sarnia—Lambton has a huge capacity for palliative care. We have a hospice with 20 beds. There are also beds in the hospital, and we have home care. We have an integrated palliative care system. There were two requests for medical assistance in dying in the first year. London, just an hour away, has a population that is about three times larger than Sarnia's population. It had 300 requests for MAID because it does not have adequate palliative care services.

The government can help out with establishing hospice. The virtual palliative care work that has started is very helpful, especially in rural and remote areas, but it of course requires broadband Internet access. The government can also use some of the successful models, like using paramedics in their off hours, to deliver palliative care. These things could really boost the existence of the supports people are being counselled about, and then people could take advantage of them.

Criminal CodeGovernment Orders

2:10 p.m.

Bloc

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

Madam Speaker, if I understand correctly, my colleague thinks the Truchon and Gladu decision should have been appealed. These two individuals were refused medical assistance in dying because their deaths were not reasonably foreseeable. They both have serious degenerative diseases. People in this situation are forced to either wait or go to court.

I would like my colleague's opinion on this.

Criminal CodeGovernment Orders

2:10 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Madam Speaker, I do not have an opinion one way or the other. Quebec has its jurisdiction and its courts make decisions, but when the government has to respond to a decision, that needs to be the focus. I do not disagree with the member for Fundy Royal, who said that the government should have taken this to the Supreme Court. This is a very serious issue, not something to be decided in a rush.

There will be continual petitioning by those who want everyone to have access to medical assistance in dying. I expect the people I talked about in my speech, including minors and those who are mentally ill, will be continually legally petitioning to expand the scope, which I do not personally support.

Criminal CodeGovernment Orders

2:15 p.m.

NDP

Alistair MacGregor NDP Cowichan—Malahat—Langford, BC

Madam Speaker, today's debate is forcing all parliamentarians to step into another person's shoes and have empathy for the grievous conditions that they are suffering through. That is difficult, especially when we are lucky enough to have our health.

I understand the member's concerns with the bill, but that being said, there are a lot of people in Canada watching today's debate. Does my colleague see a value in the second reading vote on the bill to get it to committee so that we can further dissect the provisions she sees as problematic and maybe come up with some amendments?

Criminal CodeGovernment Orders

2:15 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Madam Speaker, there are certainly amendments that must happen to fix the things that are wrong in the bill. I look forward to that discussion at committee.

Criminal CodeGovernment Orders

2:15 p.m.

St. Catharines Ontario

Liberal

Chris Bittle LiberalParliamentary Secretary to the Minister of Transport

Madam Speaker, before I begin, I would like to state that I am splitting my time with the hon. member for Winnipeg North.

We have a serious issue before us, the issue of Bill C-7. It has been an excellent debate so far and an excellent opportunity for members on all sides to talk about this issue because it goes to our morality and to our own conscience, and we are hearing from all sides about this. I want to say that we got it wrong with the last piece of legislation; we got it wrong with Bill C-14. I want to commend the Attorney General for coming forward with Bill C-7.

I would also like to recognize a few members who were vocal advocates, working on the justice committee with Murray Rankin at the time; the hon. member for Saanich—Gulf Islands; my friend, the hon. member for Don Valley West and many other members of the Liberal caucus who tried to advance medical assistance in dying so that it would be constitutional.

I am here today to speak in support of Bill C-7, which proposes amendments to medical assistance in dying legislation. Members are aware that the Superior Court of Quebec found the eligibility criterion of reasonably foreseeable natural death from the Criminal Code made legislation to be unconstitutional. The court delayed the effect of the ruling to allow both the federal and Quebec legislatures to respond. The government has agreed with this basic principle of this decision and is now proposing to amend the Criminal Code.

Bill C-7 proposes to repeal the requirement that natural death be reasonably foreseeable. It would create two sets of safeguards: one for those whose death is reasonably foreseeable and another for everyone else. Some of the existing safeguards for those who are dying would be relaxed, and for everyone else there would be a different set of safeguards based on the current ones with some additions and clarifications.

Bill C-7 proposes to continue to use the expression, “reasonably foreseeable” natural death, but as an element that determines which set of safeguards to use and not to use it as an eligibility criterion, which was the issue in the Truchon case.

The proposal to distinguish MAID requests on the basis of whether a person's death is reasonably foreseeable is consistent with the view that MAID for people whose death is reasonably foreseeable presents less risk and complexity than other circumstances, and that the assessment of requests should be tailored to these different types of cases. Having a reasonably foreseeable natural death would also be a critical element for another proposed amendment in the bill. Currently, the MAID law requires the practitioner to give the patient the opportunity to withdraw consent or to affirm their consent just before MAID is provided.

This requirement for final consent is a safeguard; however, it has also caused some MAID patients to choose to end their lives earlier for fear of losing their capacity to provide final consent and, sadly, for some to be denied MAID entirely after losing capacity. I would also like to point out that others chose to decrease their intake of painkillers prior to MAID being provided, to ensure they retained capacity to consent, which leads to an increase in suffering.

BillC-7 would allow for a possible waiver of requirement for final consent for individuals whose death is reasonably foreseeable but where there are fewest risks and complexities in providing MAID to a person who is no longer able to consent. Permitting this proposed waiver of final consent would respond to scenarios like that of Audrey Parker of Nova Scotia, who was diagnosed with terminal cancer that had spread to her brain leaving her uncertain as to how long she would have the capacity to consent. Because she feared losing capacity before her preferred date to receive MAID, she scheduled MAID and ended her life earlier than she wanted. She openly expressed how she felt unfairly forced by the limitations of the MAID law to schedule MAID sooner than preferred and called for amendments to the Criminal Code so that others like her would not be denied the freedom to choose their preferred date to receive medical assistance in dying.

I would recommend that all members listen to the speech in the previous session from the hon. member for Dartmouth—Cole Harbour. I believe Audrey Parker was a constituent of his. He powerfully used her own words to show us where we went wrong, the impacts our failures in the previous legislation had led to, and the impacts on her life. We owe it to people like Audrey Parker, who have been assessed and approved for MAID, to respect their need for freedom in making end-of-life choices. As a compassionate society, we know we can do better to support these individuals. These amendments seek to do just that.

Waiving final consent is, however, an ethically complex question. This is because it involves MAID being administered to a person who is no longer able to consent, or to withdraw the consent they previously gave. Bill C-7 proposes a new approach for patients whose death is reasonably foreseeable, who are assessed and approved for MAID when they have the capacity, and who make very specific arrangements with their practitioner in which they give consent in advance to MAID being administered on a specific day, even if they have lost capacity by that day.

I fully support permitting advance consent for this group of individuals, but at the same time, I note that certain protections must be in place. Specifically, if on the specified day for MAID, the patient has lost their capacity and they nonetheless actively show signs of resistance to the MAID procedure, or behave in a way that indicates a refusal, the practitioner must not follow through on the procedure.

Medical practitioners at the round table expressed concerns in relation to the emotional burden that could arise from such situations, for them and for family members. They talked of possible disagreement with family members on whether to end the life of a person who appears to resist the procedure. A similar situation led to the prosecution of a MAID provider in the Netherlands and made headlines around the world. That situation is what we wish to avoid here in Canada.

That is why Bill C-7 proposes an additional provision that states that signs of resistance from the patient would make the advanced consent invalid on the specific day and going forward. While an incapable person could no longer withdraw their consent from a legal perspective, given their track record and decision-making capacity, it is proposed that MAID not be permitted under this circumstance. The approach provides much needed clarity for practitioners and family members that MAID be prohibited if the patient is resisting. The bill would also make it clear that an anticipated reflexive response, like flinching when the needle is inserted, does not count as resistance.

It is important to be clear, however, that this amendment is not about advance requests. Advance requests for MAID refer to a situation in which a person puts in writing they would want to receive MAID at some later date when they are not able to consent to it, if circumstances arise that they predict would cause them unbearable suffering.

In this situation, a person is not asking for MAID now. Instead, they are putting in writing that they want it at a later date on the basis of anticipated suffering that has not yet happened. The most likely scenario would involve people who are diagnosed with conditions that could lead to dementia, such as Alzheimer's. These people would want to have a plan in place if their worst fears should come to pass.

Bill C-7 does not propose to allow MAID on the basis of advance requests. MAID in these circumstances would be extremely complex, would avoid ethical challenges and would require more time to consider such measures. In speaking to the Attorney General, I voiced my concern that we need to spend more time considering these measures. I hope that the issue will be studied during further upcoming parliamentary review of the MAID legislation.

Taking more time to study advance requests is consistent with the approach of the Government of Quebec, which is also moving forward to hold public consultations on the issue so that all of its dimensions can be better understood.

MAID is one of the most sensitive and challenging social issues we are currently faced with. Recognizing how deeply personal this issue is to so many people, and to so many members of this place, the government has listened carefully to the diverse opinions of Canadians and has considered the expertise shared by experts, MAID providers and other experts in the development of this important piece of legislation. Bill C-7 responds to the Superior Court of Quebec ruling, but it also achieves balance that respects personal autonomy, while protecting the vulnerable as well as equity rights for all Canadians.

For these reasons, I call on all members to support the bill.

Criminal CodeGovernment Orders

2:25 p.m.

Conservative

Ted Falk Conservative Provencher, MB

Madam Speaker, I want to confirm to the House that the parliamentary secretary, in his speech, spoke the truth when he said that the Liberals got it wrong, because the Liberals did get it wrong. I was on the justice committee with the hon. member when Bill C-14 was before it, and the Conservatives presented over 100 amendments that would have strengthened the bill and provided proper safeguards, all of which were rejected by the Liberal government of the day. One thing that did get passed was the requirement for a mandatory review after five years, but the government has circumvented the requirement with a few consultations, which is completely inappropriate and should be unacceptable to the House.

Health care professionals in my riding are continually asking for better health care conscience protection rights for health care professionals. They have looked at the legislation and do not feel it is there. We have heard the Liberals argue that it is there and that it is adequate, but the health care professionals in my riding, including doctors and nurses, say it is not adequate. I would like the member to respond to that.

Criminal CodeGovernment Orders

2:25 p.m.

Liberal

Chris Bittle Liberal St. Catharines, ON

Madam Speaker, perhaps the hon. member forgets that we had witnesses come before the committee and I asked them about this time after time. Can the member name me one time in Canadian history when a doctor has been forced to do a medical procedure against their will? No one, in the history of this country, has been made to do that.

I appreciate the member's revisionist history that suggests the Conservative amendments would have made the bill constitutional. On the contrary, they would have made it worse.

This is a more progressive way to move forward to protect the constitutional rights of Canadians. We still need to do more, and I look forward to the parliamentary review in the near future.

Criminal CodeGovernment Orders

2:25 p.m.

Bloc

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

Madam Speaker, I commend my colleague on his speech. I found it very interesting to hear him talk about consent and the requirement for final consent, which forced some people to apply for medical assistance in dying earlier than anticipated.

Perhaps my colleague agrees with the idea of expanding the concept of waiving final consent so that there is a type of advance consent, including in cases where natural death is not foreseeable. I would like his opinion on that.

Can he provide a concrete example of how we might proceed?

Criminal CodeGovernment Orders

2:25 p.m.

Liberal

Chris Bittle Liberal St. Catharines, ON

Madam Speaker, I believe the parliamentary review that was enshrined in the legislation needs to move forward. We have to focus on this piece of legislation right now, but we need to do better. This legislation is a big step forward, but there is a lot more work that still needs to be done.

Criminal CodeGovernment Orders

2:25 p.m.

Liberal

Bob Bratina Liberal Hamilton East—Stoney Creek, ON

Madam Speaker, I remember in the first go around, back in 2016, the controversy and the various points of view that were brought forward, including by my colleague from St. Catharines. I remember speaking to people in my riding about how proud I was that we were able to come forward with the bill. We heard some positive statistics earlier about people whose suffering was ended through the bill we brought forward.

I would ask my friend from St. Catharines about the point of view that we need to be exactly perfect when we come forward with Canada's legislation on assisted dying. At least we are at a point now that we can consider some very good things that have happened and a way of improving them.

Criminal CodeGovernment Orders

2:30 p.m.

Liberal

Chris Bittle Liberal St. Catharines, ON

Madam Speaker, I appreciate the hon. member's comments. However, I look at this in a different way, because many of these concerns were brought to the attention of the decision-makers previously. Those voices were ignored and people suffered unnecessarily. I take this as a personal loss and wish my voice could have been stronger to prevent that suffering. We took a step forward with the previous legislation, but we need to keep taking steps forward.

Criminal CodeGovernment Orders

2:30 p.m.

Liberal

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

The motion that the House do now adjourn is deemed to have been adopted. Accordingly the House stands adjourned until Monday, October 19, at 11 a.m. pursuant to Standing Orders 28(2) and 24(1).

Happy Thanksgiving, everyone.

(The House adjourned at 2:31 p.m.)