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

Misidentification by Parliamentary Television ServicesPoints of OrderOral Questions

12:05 p.m.

Conservative

Jag Sahota Conservative Calgary Skyview, AB

Madam Speaker, during my statement during Statements by Members, the parliamentary television services listed me as the Liberal member for Brampton North. While I share the same last name, I am not the member for Brampton North and definitely not a Liberal. This, unfortunately, is not the first time. During my speech in reply to the throne speech, the parliamentary television services listed me as the member for Kelowna—Lake Country.

This is very concerning to me, and I ask that you look into this matter.

Additionally, I believe if you seek it, you will find unanimous support for me to redeliver my statement.

Misidentification by Parliamentary Television ServicesPoints of OrderOral Questions

12:05 p.m.

Liberal

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

I thank the member for raising this point. We will most certainly look into it.

Does the member have unanimous consent to proceed?

Misidentification by Parliamentary Television ServicesPoints of OrderOral Questions

12:05 p.m.

Some hon. members

Agreed.

International Day of the Girl ChildOral Questions

12:05 p.m.

Conservative

Jag Sahota Conservative Calgary Skyview, AB

Madam Speaker, it is International Day of the Girl Child. As the shadow minister for women and gender equality, I would like to celebrate the strides Canada has made thus far in empowering and protecting girls, but we still have a long way to go to overcome gender inequality.

Sadly, the present government continues to fail Canadian girls during this pandemic by cutting funding to organizations such as the London Abused Women's Centre, an organization that protects and helps girls in instances of abuse or human trafficking. Women and girls can be assured that under a Conservative government, Canada would always defend, encourage and advocate for girls as community-building students, leaders and entrepreneurs, both today and tomorrow.

Let us all remember the women and girls in our communities, and support them in achieving their goals. Let us remember this momentum and carry it with us all year long because when girls succeed, Canada and the world succeed. I wish everyone a happy International Day of the Girl Child.

International Labour ConferenceRoutine Proceedings

12:10 p.m.

Mount Royal Québec

Liberal

Anthony Housefather LiberalParliamentary Secretary to the Minister of Labour

Madam Speaker, I have the honour to table, in both official languages, the report to Parliament with respect to the C190 - Violence and Harassment Convention adopted in June 2019 of the International Labour Conference held in Geneva, Switzerland.

Sex SelectionPetitionsRoutine Proceedings

12:10 p.m.

Conservative

Tamara Jansen Conservative Cloverdale—Langley City, BC

Madam Speaker, I am pleased to present an important petition that calls on the House to ban the misogynistic practice of sex selective abortion in Canada.

The petitioners recognize that a vast majority of Canadians believe that abortion should not be performed solely due to parents' preference for their baby's sex, that the practice is antithetical to the principle that men and women have equal value and that many Canadian health care professionals acknowledge that this is a real problem in Canada.

I am proud to support Bill C-233, presented by my colleague, the member for Yorkton—Melville, and I hope the government will work to move the bill forward. I truly believe that all members agree that no baby girl should have her life taken away because her parents want a boy.

RCMPPetitionsRoutine Proceedings

12:10 p.m.

NDP

Matthew Green NDP Hamilton Centre, ON

Madam Speaker, I rise with three petitions and it is very important I have the opportunity to deliver these on behalf of the residents.

The first petition is championed by Bethany Drader. The petitioners state that Black and indigenous people are more likely to experience police brutality; that Black and indigenous people are overrepresented in rates of incarceration relative to their population numbers; that the annual RCMP budget is in excess of $5 billion; that adequately trained community services can fill roles currently fulfilled by the RCMP, such as responding to mental health crises in a safe and violence-free method; and that social factors such as homelessness, poverty and lack of access to resources are the root causes to criminality, yet are chronically underfunded. They believe police involvement leads to substantially greater negative outcomes for Black, indigenous and racialized communities, such as the increased risk for the use of violence and potential criminalization. Recent instances of Black and indigenous deaths in Canada have been the result of police involvement and welfare checks.

The petitioners call on the House of Commons to divest from the RCMP—

RCMPPetitionsRoutine Proceedings

12:10 p.m.

Liberal

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

The member has three petitions, if he could please continue.

Public SafetyPetitionsRoutine Proceedings

12:15 p.m.

NDP

Matthew Green NDP Hamilton Centre, ON

Madam Speaker, I appreciate that.

The second petition is very important and timely. It is championed by Kurt Eva. While the government has a call out right now for the purchase of tear gas, this is a petition to ban tear gas in Canada, particularly its domestic use. We know that under the Geneva convention, specifically the 1993 chemical weapons convention, it is banned internationally. This very important petition has close to 12,000 people from across the country petitioning for the ban of the use of tear gas.

Income ReliefPetitionsRoutine Proceedings

12:15 p.m.

NDP

Matthew Green NDP Hamilton Centre, ON

Madam Speaker, thirdly, and critically important, is a petition championed by Jay Woodruff to immediately expand the eligibility for CERB to include those who were previously deemed ineligible due to poverty, disability or other circumstances that prevented them from meeting the minimum earnings required to qualify for CERB; that payments be backdated, to March 1, 2020; and that equal support continue to be provided for Canadians as outlined above for the duration of CERB, as well as continuing to provide support indefinitely through a guaranteed basic income, with the monthly rate increased annually to reflect the increases in the cost of living.

EqualizationPetitionsRoutine Proceedings

12:15 p.m.

Conservative

Tom Kmiec Conservative Calgary Shepard, AB

Madam Speaker, I present a petition on equalization from petitioners in my riding. They are asking the Government of Canada to enter into negotiations with the Province of Alberta and negotiate a fair deal for Alberta in the equalization program.

Questions on the Order PaperRoutine Proceedings

12:15 p.m.

Winnipeg North Manitoba

Liberal

Kevin Lamoureux LiberalParliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons

Madam Speaker, I ask that all remaining questions be allowed to stand at this time, please.

Questions on the Order PaperRoutine Proceedings

12:15 p.m.

Liberal

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

Is that agreed?

Questions on the Order PaperRoutine Proceedings

12:15 p.m.

Some hon. members

Agreed.

The House resumed consideration of the motion that Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

Criminal CodeGovernment Orders

12:15 p.m.

St. Catharines Ontario

Liberal

Chris Bittle LiberalParliamentary Secretary to the Minister of Transport

Madam Speaker, I know the member and I had a lot of debates four years ago when we discussed this on the justice committee.

Conscience rights for doctors have come up a bit in his remarks and in other members' remarks as well. I was hoping we could take it back to our profession. As a lawyer, and as a civil litigator, I have had a number of individuals whom I met with and, through my own conscience, I did not want to take on their cases, but I was required by the Law Society of Ontario to refer those individuals on, even though I may not have wanted them to succeed or have success in their cases.

I was wondering if that was the same case in Alberta, and why is it different in that particular case? Should doctors not be required to refer patients on?

Criminal CodeGovernment Orders

12:15 p.m.

Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, yes, it is correct that the member and I did serve on the justice committee together during the deliberation and study on Bill C-14.

When we speak about conscience protections, they are fundamentally important. It is important to remember that the Supreme Court of Canada, in the Carter decision, did recognize that Canadians have a right, in certain circumstances, to physician-assisted dying, but at the same time the court expressly stated that no physician should be compelled to provide the procedure. It is important that the Carter decision be respected.

Criminal CodeGovernment Orders

12:15 p.m.

NDP

Randall Garrison NDP Esquimalt—Saanich—Sooke, BC

Madam Speaker, I listened with interest to the hon. member's speech before question period, and I respect that his concerns about Bill C-7 are based on deeply held convictions. Therefore, I wonder whether he would support my attempt to get the government to start the broader review of the bill in parallel with Bill C-7, according to the motion I placed on the Order Paper earlier today.

Criminal CodeGovernment Orders

12:15 p.m.

Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, that is something I will give consideration to, but what is disappointing is that it has come to this. It need not have been so. The government could have very easily proceeded with a legislative review that would have been able to address all of the underlying issues associated with the bill, instead they have opted for a rushed process.

Criminal CodeGovernment Orders

12:15 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Madam Speaker, when Bill C-14 was discussed, I did warn the House that if we look to other countries and how they enacted medical assistance in dying, we would see that they began with death rates in their countries of less than 1% and grew to 8%, through people not following the safeguards. It seems to me that the government, in the new version, has removed all of the safeguards: the reasonably foreseeable death provision, the independent two witness provision, the 10-day cooling-off period provision and asking for consent immediately prior.

Would the member agree that all the safeguards have been removed, or are there ones that still remain in place?

Criminal CodeGovernment Orders

12:20 p.m.

Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, I can say that some of the key safeguards that were deemed to be essential in Bill C-14 have been removed. The member speaks about the 10-day reflection period. It is unclear why that was removed when the law, as it stands, currently provides an exception for cases where the lack of capacity to consent is imminent. That would provide for a shorter reflection period, so it is unclear why the government would choose to remove it altogether.

With respect to the removal of the need for providing two witnesses, the need is now to provide only one witness, which is in fact a lesser safeguard than what is required when a testator executes a will.

Criminal CodeGovernment Orders

12:20 p.m.

Parkdale—High Park Ontario

Liberal

Arif Virani LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada

Madam Speaker, in respect of the most recent intervention by the member for Sarnia—Lambton, the provisions, in terms of complying with Truchon, have eased in terms of safeguards. Other safeguards have actually been enhanced. Therefore, when someone's death is not reasonably foreseeable, we now have a situation where one of the two practitioners assessing eligibility must have expertise in the specific condition that is causing the person's suffering.

As well, we have a minimum 90-day period of assessment from the date of the request to the date of the actual delivery of the service, which is not something that is contemplated by the Truchon decision. It is an additional safeguard that has been put in place.

I would ask the member to comment on those components, as well as the components that address palliative care and the need to understand that palliative care is provided as an option, and physicians are to deem that option has been entertained by the individual applicant, which is an additional feature of this bill.

Criminal CodeGovernment Orders

12:20 p.m.

Conservative

Michael Cooper Conservative St. Albert—Edmonton, AB

Madam Speaker, in the interest of time, I will address the issue of palliative care and simply state that it was recognized that the absence of palliative care denies a patient true autonomy to make an informed choice. The government has to do a better job when it comes to establishing comprehensive palliative care across the country.

Criminal CodeGovernment Orders

12:20 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Madam Speaker, I rise today in the House to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying. It is long overdue.

I want to start by saying that the Bloc Québécois is in favour of adopting the principle of this bill, because it clarifies two aspects of medical assistance in dying.

The first has to do with access to medical assistance in dying when death is imminent, meaning that the person is terminal and is receiving palliative care before receiving medical assistance in dying. At least, I hope that is the case, because people in palliative care are not always the ones to request medical assistance in dying. I will come back to this.

The second aspect has to do with people for whom death is not imminent, who were denied access to medical assistance in dying as a result of the “reasonably foreseeable natural death” clause in Bill C-14. The court struck down this criterion, which was the key safeguard. This is what Bill C-7 is designed to fix, and we are happy about that.

As we begin debating the underlying principles of Bill C-7, it will come as no surprise that I am discussing them. It is precisely because we, as lawmakers, did not do our job four years ago when we were studying Bill C-14, that we find ourselves debating Bill C-7 today.

This is a democracy, and parliamentarians, not judges, must make the laws. We, the representatives of the people, the lawmakers, must be the voice of Canadians, especially those who are suffering. Judges only interpret the grammar of justice. They examine the laws we make, as well as the rights and freedoms, and determine whether a potential infringement of rights and freedoms is reasonable or not.

In this case, the court has handed down its ruling: The provisions of the current law, the former Bill C-14, are an unreasonable infringement of rights and freedoms. Furthermore, before Bill C-7 was tabled, two courts had ruled that the Criminal Code, amended by Bill C-14, violated the right to life, liberty and security of the sick person suffering intolerably or with a terminal illness.

We have to be clear about the issue at the heart of this debate: before being legal, this is an ethical debate. On one side of this debate is the paternalistic vision of the state and medical practice, while on the other side is a vision based on the autonomy of the individual and its corollary, the principle of self-determination. I know that all my colleagues in the House have good intentions. They want to do good, they want the best for patients and they are caring. I am sure that during this entire debate they will reflect the very values they are advocating and they will be just as caring and compassionate about the interests of patients.

However, we cannot claim to be caring and compassionate, in other words wanting to do good and what is best for an individual who has reached their breaking point at the end-of-life stage, if we are interfering with that individual's autonomy and self-determination, and if we refuse to respect their wishes on something as personal as their own death. The literature is clear on this.

The basic question is this: What business does the state have interfering in a decision as personal as my own death? My life is my own, as is my death. No one else, and certainly not the state, is going to die in my place. The courts had to reframe the limits of the state's power to intervene because we did not do our job properly.

All I want is for us to understand what is at stake here. I am referring to the law, which my Conservative friends often put up on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. That is what I want to discuss here today with my colleagues. Let's talk about the autonomy bestowed on a person by law through the principle of self-determination.

In the biomedical context, the principle of self-determination is associated with an inviolable rule, namely the rule of free, informed consent. The rule regarding free, informed consent to treatment has never been challenged in emergency situations. Patients always have the right to refuse treatment.

My question for my colleagues is this: Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition? Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

In the Carter decision, which led to Bill C-7, the Supreme Court ruled that the provisions prohibiting medical assistance in dying violated the right to life, liberty and security of the person. People like Ms. Gladu, Mr. Truchon, Ms. Carter and Ms. Taylor have not reached the end-of-life stage. They might not even be in the terminal phase of their illness. That does not mean they have not reached, or are not in the process of reaching, the limit of what they can tolerate.

The court stated that the restrictive provisions in Bill C-14 were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is what needs to be fixed right here, right now. Bill C-14 did a fairly good job covering the end-of-life care for terminally ill patients whose death was reasonably foreseeable, with the exception of the requirement for a second consent, which is sometimes not necessary and means that people suffer even though they gave their informed consent.

There is no issue for people who are terminally ill. The dying process has already begun and is irreversible. Death is imminent and foreseeable. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent. Under Bill C-14, Ms. Carter, Ms. Taylor, Ms. Gladu and Mr. Truchon were ignored.

What we, the members of the Bloc Québécois, want is respect for the moral autonomy of the dying. We often hear the expression “dying with dignity”. I must point out that dying with dignity does not mean having a sanitized death. That is not what it means to die with dignity. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. That is what it means to respect a human being. When that is violated, we violate the dignity of the human being.

Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life. Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, this was called passive euthanasia. The person was left to die without much attention and without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, but it always ends up causing death. Because palliative care is still care, it does not strictly count as passive euthanasia.

Patients won the right to die rather than undergo aggressive therapies, because people did not use to die from cancer; they died from the treatment. Medical paternalism has at times gone too far and has been less than helpful.

Today's patient-practitioner relationship prioritizes collaboration, negotiation and respect for the patient's choice. Patients alone can assess their quality of life, and that must be respected, which is why medical professionals must be transparent with their diagnoses.

Patients won the battle for the right to die rather than undergo aggressive treatment, and that evolved into palliative care as we know it. For a long time, palliative care was thought of as the only solution that would allow people to die with dignity, but if that is the case, why is it still so hard for people to get that care? If that is the solution, why is there still such a shortage of palliative care units?

Sometimes, even the best, most carefully managed palliative care in the world cannot alleviate people's suffering. Bioethics teaches practitioners to remember that patients come first, and that means listening to them.

That is true for Ms. Rodriguez, Ms. Carter, Ms. Taylor and Mr. Truchon, and it is true for Ms. Gladu and many others who have continued to suffer throughout this pandemic while they wait for us to do our job. Contrary to what some people think, these individuals are not suicidal. They want to live as long as possible.

I watched a very interesting interview with Ms. Gladu. What did she say to us? What did she want? She wanted the freedom to choose. Having this freedom greatly diminishes the suffering and anguish.

With Bill C-14, the government said its intention was to protect the most vulnerable. Is there anyone more vulnerable than a person who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity? Is there anything more important and more intimately personal for an individual than their own death?

I have a hard time understanding my Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian. Several Conservatives felt that Bill C-14 went too far. The courts said that it did not go far enough and that it violated fundamental rights.

Elected members of the National Assembly of Quebec advanced the debate without pitting palliative care against medical assistance in dying. They chose to include requests for assistance in dying as part of a continuum of end-of-life care that is consistent with palliative care. Whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal, let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity, their freedom to choose.

There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

The Carter decision and the Baudouin ruling sent us back to the drawing board. We need to do our job as legislators and stop off-loading the problems and the ethical, social and political questions onto the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill, but we will have plenty of time to discuss them in committee.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent, since that is about all that is missing from the bill.

Bill C-7 does not address degenerative cognitive diseases, which are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years and do not appear to be sick, but eventually, they become forgetful and then die. They can also experience complications from being bedridden or immobilized or conditions other than that disease. I think a person with Alzheimer's, for example, should have the opportunity to make an advance request. This bill does not take those people into account.

Still, I said at the outset that we agreed on the principle and the grounds for discussing this bill. We will have time to talk about these issues. I urge my colleagues to bring substantive arguments to the debate on the adoption in principle of medical assistance in dying.

I remember when the previous Parliament studied Bill C-14. I heard arguments about how we were putting ourselves on a slippery slope. Some people were practically saying that long-term care homes would turn into euthanasia factories. If evil people are working in our health system, they should be fired, no matter what job they do, because they have no business there. I am not buying the argument that this is a slippery slope because people are evil.

We must assume from the outset that everyone working in the health care system is caring and compassionate. Increased health transfers would enable these people to provide better care, and maybe there would be more palliative care units in hospitals. Even though people have been saying for 50 years that palliative care is the only solution, I do not believe it is. It makes no sense that people do not have better access to palliative care in this day and age.

I would like to end my speech, which I trust was a substantive one, with a wish for all of us, here in the House, concerning the delicate issue of the end-of-life. I sincerely hope—which is what the patients who turned to the courts were hoping for—to face death serenely, peacefully and without suffering. That is my wish for everyone, because that is the best wish we can make for a human being. We should imagine ourselves being at peace on our death bed and being able to let go because we have palliative care to support us in our journey towards death. That is the best wish we can make for a human being.

I am therefore calling for a debate on both the substance and the principles. I am also appealing to the humanity of all my colleagues so we can finally provide an adequate response to all those who are suffering and have been waiting for far too long.

Criminal CodeGovernment Orders

12:40 p.m.

Parkdale—High Park Ontario

Liberal

Arif Virani LiberalParliamentary Secretary to the Minister of Justice and Attorney General of Canada

Madam Speaker, I would like to congratulate my colleague, the member for Montcalm, for his very honest, very direct and very analytical speech.

I would simply like to highlight a theme he raised, the protection of individual autonomy and also of vulnerable persons. We are proposing to eliminate the 10-day waiting period because our consultations indicated that, in reality, this waiting period does not safeguard anyone; rather, it prolongs their suffering because vulnerable people want to act without delay, certainly faster than after 10 days. What does the member think of the idea of eliminating this 10-day period, and will this help better protect vulnerable persons?