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.