Debates of Oct. 9th, 2020

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, as I noted, this aspect of the bill seems perfectly adequate.

Far too often people who were dying, who were at the end-of-life stage, still had to wait another 10 days. Sometimes that second consent meant reducing sedation to be sure that the person understood exactly what was at stake. Sometimes the sedation is reduced so much that the person ends up suffering for no reason because everything that had already been done was clarified several times. Indeed, it was an unnecessary safeguard that made people suffer unnecessarily.

I think there are also contextual issues. If they have any doubts about doing what needs to be done, practitioners are also able to get that certainty in a clear and precise way. I think that is an important addition to Bill C-7.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I listened with great interest and care to the member's speech. It was an important contribution.

I know the member is aware that the original legislation, Bill C-14, required a broader legislative review of medical assistance in dying. That review was supposed to start in June.

Will the member and members of the Bloc be supporting efforts to get this broader review going in parallel with Bill C-7?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, absolutely, as critic on the matter, that is what I wanted in February. There are some issues that remain on hold and that should be discussed at greater length during the legislative review. I hope that review will start as soon as possible.

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

Madam Speaker, I thank my colleague for his speech, which was compassionate and inspiring, not to mention very well put together and documented. I am very proud that he is our colleague.

He spoke about the fact that, without the bill, some people would resort to the courts to finally win their case. Another option for some would be to go abroad to obtain MAID.

In this context, does he believe that the bill provides a better framework for MAID and ensures that everyone has equal access and that finances are not an impediment?

Those with the means to go abroad can do so even if they are far from their family and home, whereas others cannot. In a context of harm reduction, shaping the bill ourselves and offering it to everyone, rather than trying to make it impossible to do something, which is in any event somewhat inevitable—

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

The hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, that is a very good interpretation of the positive effects of the bill.

We must absolutely ensure that people are supported when they are about to die so they may have a better death. In addition to the issue of money, I find that going abroad is not an appealing or adequate solution. It is an interesting point.

However, I believe that we should further expand access to MAID with advance requests. I find that is an important element that is missing from the bill.

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

Madam Speaker, I want to ask the member a question respecting advance consent. In the bill, there is no time limit in which that consent would expire. If contemporaneous consent is no longer required, does the hon. member see the need for a time limit in terms of the validity of such a waiver to guard against someone who, hypothetically, could make a request well in advance and have the procedure carried out while very ill without their knowing?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the bill does not provide for advance requests. There is just a 90-day waiting period for people who are not terminally ill but who are in a situation like Ms. Gladu's or Mr. Truchon's. There is a 90-day waiting period after medical assistance in dying is requested. Bill C-7 does not cover the issue of advance requests.

We are going to amend the bill for people with degenerative diseases. At that point, I think we can talk about what kind of provisions would cover that aspect of dying with dignity.

[Kevin Lamoureux, Liberal, Parliamentary 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 appreciate the member's comments about the importance of people to share their real thoughts on such an important issue. In the last go-around we had a great deal of discussion about palliative care, which I hope to address further at an opportune time. One of the benefits of having this debate is that we become a little more sensitized to some of the other things that we could be doing. Palliative care for me is really important.

Does my colleague have any further thoughts on the issue of palliative care? Communities do need to focus more resources in that area.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the funny thing is that people have been saying it is the only solution for 50 years now. Why is it that some hospitals still do not provide palliative care because there is a shortage of units?

Nowadays, in some hospitals, people who request medical assistance in dying cannot experience that end-of-life journey in a palliative care unit, even though palliative care is supposed to be end-of-life care and relief from pain and suffering in an environment that supports human dignity. How is that possible?

We must not think of palliative care and MAID as being mutually exclusive. It is a continuum of care that should be available to these patients. Those who are not terminally ill, for whom the dying process has not already begun and is not irreversible, are also entitled to a suitable environment. Bill C-7 makes that possible, and much more clearly than Bill C-14 did.

That was not possible under Bill C-14, with its unassailable reasonably foreseeable natural death criterion, which the court said undermined patients' right to life.

House of Commons Calendar

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

Pursuant to Standing Order 28(2)(b), I have the honour to lay upon the table the House of Commons calendar for the year 2021.

Resuming debate, the hon. member for Esquimalt—Saanich—Sooke.

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 Code

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, let me start by saying how much I would rather be in the House today than at home managing a small raise hand function on the screen and our own barking dogs. More seriously, let me say how much I would rather have completed this debate in March when it comes to avoiding or preventing unnecessary suffering.

COVID-19 has required us all to make adjustments. Obviously the adjustments we have to make as parliamentarians pale in comparison to the experience of most Canadians, especially those who have lost loved ones to COVID-19; those who have lost their livelihoods; those who are still struggling to make ends meet, to keep a roof over their head and to put food on the table; and those who are struggling with the pandemic while contending with life-threatening illnesses.

Let me also preface my remarks on Bill C-7 with a few words on why we find Bill C-7 before the House at all. There is a tendency by both the Liberals and Conservatives to emphasize that we are here because of a deadline imposed for changes in medical assistance in dying by the Quebec Superior Court decision in the Truchon case. That is true technically.

However, it obscures the role of the plaintiffs in that case, Jean Truchon and Nicole Gladu, who went to court to contest the provisions of Bill C-14, which they found violated their charter rights by causing or prolonging unnecessary suffering for those at the end of life and for denying individuals autonomy of decision-making over the end of their own lives.

I actually want to thank the plaintiffs today who brought us here, and also to stop for a moment to express my condolences to the family of Mr. Truchon, who left Canada a better place as a result of his attempt to improve the way we deal with medical assistance in dying, when he left us in April.

When it comes to medical assistance in dying, for New Democrats, our priority has always been, and remains, avoiding unnecessary suffering being inflicted on those who are already suffering from terminal illnesses and at the same time avoiding prolonging suffering for their families who have to bear witness to that suffering.

We were glad to see this legislation come forward in February, very promptly for a new government, but we are disappointed that we are here in October, starting over again. Some of this delay was due to COVID-19, but the blame for this delay lays equally at the feet of the Liberals for proroguing the House.

In February, there was recognition by all parties that there were two pieces of work outstanding on medical assistance in dying. First was the need to amend Bill C-7 to conform with the charter as demanded by the Quebec Superior Court ruling in the Truchon case, which found the current law too restrictive. This is the very reason New Democrats voted against Bill C-14 when it originally came before the House.

Even before the court ruling, there were many calling for changes. Those who listened carefully to the terminally ill, their families and practitioners providing the medical assistance knew well the unnecessary suffering that was being inflicted, and continues to be inflicted by our current law.

The second task with regard to medical assistance in dying was to conduct a legislative review of the broader issues around MAID after four years of our experience with it. This is not to be confused with a normal review of the specific legislative changes proposed in Bill C-7. This broader legislative review of the issues arising out of medical assistance in dying was mandated in the original legislation and was supposed to start this June.

Bill C-14 required that the review specifically look at the question of advance requests, requests from mature minors and requests where mental illness is the sole underlying condition, but it was not to be limited to those topics.

I am disappointed that the second task appears to have fallen off the agenda for the Minister of Justice. Early this morning I asked him to commit to starting this broader review in parallel with the examination of the changes in Bill C-7. As I told him then, I put Motion M-51 on the Order Paper today to create a special committee of the House that could conduct this broader review at the same time as the justice committee deals with the urgent changes needed and required because of the court decision and because of the unnecessary suffering inflicted by our current law.

I want to talk about each of these two tasks in more human and practical terms by starting with very personal stories, one for each of these. It is clear to me that the current legislation has some unintended and cruel consequences. These were clearly demonstrated by what happened to a very good friend of mine.

On January 1, 2019, I went to a traditional New Year's levee in one of the communities in my riding. When I arrived, I was not surprised to be greeted enthusiastically by someone I had become close friends with over 10 years involvement in public life together. I was surprised, however, to see her right arm was in a sling.

I am not going to name this friend today because I did not seek formal permission from her family to do so, but I am telling her story today as I trust she would want her unfortunate experience with medical assistance in dying to make a difference.

When I asked my friend what was happening, she recounted how, suddenly and inexplicably, she began having trouble using her arm over the holidays and that she was going to have it checked out as soon as possible. A month later, she began to see other symptoms and she found out that she had an inoperable brain tumour the size of a raisin but growing, growing slowly but growing nonetheless. This was a condition that would prove to be painful, debilitating and terminal.

As her condition rapidly deteriorated, she began to make plans for her end of life. Just four short months after a diagnosis, my partner and I received an invitation to what she was calling a masquerade ball in her honour. My friend was incredibly brave and never lost her sense of humour or her love of life right up to the end.

On that Saturday, she checked herself out of the hospital to celebrate her life with us that night. Rather than, as she joked, allowing us to get together after she was gone and talk about her then, she preferred to see us before and to hear what we had to say before she had to leave. Just days later, we found out she was gone. With her death, we were not only deprived of a larger-than-life member of the local arts community. We were also deprived of a friend whose enthusiasm for life had always been infectious.

Why such a sudden exit? The current law requires that those who have already been assessed and approved for medical assistance in dying be competent when the final moment to receive that assistance comes. Therefore, my friend was forced to depart weeks if not months early because she feared the loss of competence that might result from her brain tumour if she waited too long, and that this loss of competence would prevent her receiving medical assistance in dying and thus inflict weeks or months of suffering on her as the patient but also, more important to her, weeks of suffering on her family and friends who would be forced to witness a prolonged dying.

Bill C-7 would fix this by removing the requirement for final consent for those who are already assessed and approved for medical assistance in dying. This would take away the need to go early in order to avoid the loss of competence that now prevents receiving medical assistance in dying.

The bill would also make the process more straightforward in several other ways. It would do so by taking away the mandatory 10-day waiting period, reducing the number of witnesses required from two to one and expanding who could serve as a witness. These are all things practitioners have told us are unduly restrictive and only end up unnecessarily prolonging suffering.

Right now, I should take a moment to thank four doctors who have been kind enough to share with me their experiences in providing, or not providing in some cases, medical assistance in dying to hundreds of patients. Again, I will not name them today to respect their privacy, but my conversations with these four incredible people have helped me understand how medical assistance in dying operates in real life.

I should mention one other change in Bill C-7 that would have more substantial impacts. That is the removal of the requirement that death be imminent before one can receive medical assistance in dying. Bill C-7 then sets out a more restrictive process than that for those whose death is imminent and where there is more time for assessment and decision-making. However, I should emphasize, Bill C-7 still maintains the high standards set in the original legislation that in order to receive medical assistance in dying patients must have a condition that is incurable, must be in a state of irreversible decline and must face intolerable suffering. This means that Bill C-7 would not open the door for medical assistance in dying quite as wide as some have suggested.

My second story, also very personal, deals with one of the broader issues that the review of MAID was supposed to deal with. This story is my mother's story. My mum passed away just short of five years ago, during the debate on MAID. This is a story I have told before during the debate on the original bill, but one which still lacks resolution.

My mother had always been very clear with my sister and me about her wishes regarding the end of her life. For her, it was simple. She asked us that if she ended up bedridden, unable to shower or feed herself, and did not know who we were, then to please let her go. She suffered from dementia and other underlying conditions that were complicated by a serious fall and, fortunately for her, she was not forced to endure for long those conditions she had feared.

Unfortunately, the kind of advance directive or advance request that my mother had wanted to give is still not allowed under the existing legislation. I know many in my community, and more specifically, many in my own social circles, fear just such an outcome and feel that they should be able to make their own end-of-life wishes known and have them respected, just as they are now when it comes to questions of refusal of medical treatment. I tend to be of the same opinion. However, my discussions with practitioners providing medical assistance in dying have persuaded me that this question is not as simple as it appears on its face. This remains one of the important issues the legislative review of the current legislation can address and is mandated to address by Bill C-14.

As I mentioned earlier, there were other issues that were assigned to this broader review in the original Bill C-14, including requests from mature minors and requests for mental illness as the sole underlying condition, but one concern was missed. Let me take a moment now to address the concerns of disability advocates that, with the removal of the requirement that death be imminent, there will be pressure on the vulnerable in our society to choose medical assistance in dying.

First and foremost, as a society we can and must do better in offering support to people with disabilities. Failure to provide necessary resources to ensure that everyone can enjoy full and equal participation in life is a current and ongoing black mark on all of us. We have only to look at the failure to deliver additional assistance promptly to persons with disabilities during this pandemic to remind ourselves how often we forget about those living with disabilities. However, we should not dismiss the concerns of the disability community about medical assistance in dying out of hand. The legislative review is the place for us to consider seriously the question of whether the existing safeguards preventing pressure on the vulnerable to choose medical assistance in dying are, in fact, sufficient.

Before I conclude, I want to remind members that, as a society, we must do better in the job of end-of-life care. Again, COVID has demonstrated the tragic deficiencies in long-term care in ways I hope we will not ignore.

New Democrats will support the bill and help expedite its passage in order to bring an end to unnecessary suffering and to meet the deadline imposed by the Quebec court in the Truchon decision, but this support has always been predicated on going forward with a larger review without delay.

I have drafted a motion, Motion No. 151, which I have tabled today. I look forward to hearing a positive response from the government on this. We have just heard a positive response from the Bloc, and I am hoping for a positive response from the Conservatives.

Proceeding with Bill C-7 without proceeding with the broader review is only getting half the job done on medical assistance in dying. At the same time, failure to conduct the broader review potentially undermines public support for medical assistance in dying, which, so far, has only continued to grow. In fact, I believe this is one of the most important questions that could ever come before Parliament.

I look forward to the debate on the specific improvements that we can make to Bill C-7, but I urge all of us to consider undertaking the broader review of issues around medical assistance in dying without delay.

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

Madam Speaker, I thank the member for Esquimalt—Saanich—Sooke for his comments today, his work on the justice committee, his support for this legislation and also for underscoring the important role that the litigants have played in the evolution of this.

I would highlight the theme that the member raised when he talked about the sanctity of life. It is quite clear for those who have read the jurisprudence, and I know that he has, that in both the Carter and Truchon decisions the courts talked about the notion that the charter protection of the right to life under section 7 means that when people are prematurely considering availing themselves of medical assistance in dying because they worry about being able to give that final consent and having the capacity to give that final consent, when they take their lives prematurely, it actually violates their charter rights. This was outlined in both the Carter and Truchon cases.

I wonder if the member opposite could comment on that aspect of the decision, because it is very important in terms of the protection of the vulnerable, which is one of the things the legislation is attempting to address.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I believe Bill C-7 raises an important question around consent at the final moment. As I said from the very personal story of my friend, I got a picture of how this works in real life.

We can talk about the court decisions, but today I was hoping to introduce the reality of the family and friends of those who are facing unbearable suffering at the end of life and who are really looking to us to make the improvements they are calling for, to make sure we do not unnecessarily prolong suffering and that we do not unnecessarily inflict it on the families of those patients.

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, since the bill has come in a second time in two sessions of Parliament, I would like to ask how important is it for the government to listen a bit more this time and to take all the amendments from different parties into consideration to make sure that the bill would be the bill we are all looking for and Canadians are looking for.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, there are two tasks here. The first is to look at the amendments to medical assistance in dying legislation in Bill C-7 to make sure that they both conform to the requirements of the court decisions and the charter, but also to make sure they reflect the lived experience of people dealing with medical assistance in dying.

The second part is the broader review. I hope we get support from the Conservatives to start this parallel review that can look at the larger questions around medical assistance in dying and make recommendations to Parliament, if necessary, for further legislation.

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

Madam Speaker, Bill C-7 proposes removing the requirement for final consent for eligible individuals whose natural death is reasonably foreseeable.

This requirement could result in a person not receiving enough sedatives to relieve their pain because they need to be fully competent at the time of the second consent.

I would like to know my colleague's thoughts on whether we should also consider the possibility of granting the right to waive final consent in cases where natural death is not foreseeable.

Should we be considering the issue of advance consent, for example, to ensure that people suffering from degenerative or incurable diseases do not have to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying?

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, the goal here is to avoid unnecessary suffering, so I am very supportive of providing for the waiver for final consent and eliminating the 10-day waiting period.

When it comes to advance directives, I tend to be in favour of people being able to make their instructions for end of life and have them respected. As I said, my talk with practitioners has convinced me that we need a broader debate about the issues around advance directives, and that is why I hope to see this parallel broader review start along with the consideration of Bill C-7.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, I appreciate the honouring of the stories. I have had a dear loved one choose to use MAID for the next step in his journey. It was a very painful and beautiful day for the loved ones who were with him. One of the things I remember distinctly is that his doctor of over 30 years was a very strong Christian. He felt he could not take that step, but still showed up and held hands with him in his final moments. I remember feeling such respect and love in that room.

When we talk about the subject, the most important thing is the unnecessary suffering. We need to end that, not only for the person experiencing it but for the pressure of watching their loved ones go through that unnecessary suffering.

Could the member speak more about how important this broader review is? When we look at advance directives and vulnerable populations, all of us in the House, regardless of our point of view, want there to be a thoughtful discussion that provides this place with very thoughtful responses and actions we can take in the future.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, I thank the member for North Island—Powell River for also sharing her personal experience with medical assistance in dying.

My background is as an academic and as a member of Parliament. I think we have the same tendency to get into the legal details and forget about the lived experiences that lie behind these kinds of cases and issues. By having a broader review of the issue around medical assistance in dying, we can help build a consensus about appropriate measures when it comes to advance directives and making sure that vulnerable populations are not under undue pressure. This review was mandated by the original legislation and was seen as an important part of the way we consider the experience we have actually had with medical assistance in dying. I am disappointed the government seems to have let this fall off its agenda and is leaving it to the rest of us in Parliament to push forward with this review.

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

Madam Speaker, my question for the member has to do with the disabled. He made a comment about the disabled and in the legislation it looks like there is a different treatment of disabled people to other people. I am concerned about that. I wonder if the member is also concerned.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Madam Speaker, the hon. member's question reflects something that I think is very important, which is that when concerns by a community are raised they be fully explored and fully considered, not just dismissed out of hand, regardless of what our own personal opinions are on those concerns. The place I believe we should do that is in the broader review conducted by the House that I suggested in the motion I tabled today. I want us to hear from the disabled community and its advocates and to think carefully about the issues they are raising. I want to make sure the safeguards we have in place to prevent vulnerable people from being pressured into selecting medical assistance in dying are actually adequate.

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

Madam Speaker, I will be splitting my time with the member for Glengarry—Prescott—Russell.

I am pleased today to speak on Bill C-7, an act to amend the Criminal Code in relation to medical assistance in dying.

As members know, clearly we are here because of the decision of the Quebec Superior Court in the Truchon case. That decision struck down a particular criterion under both the Quebec and Canadian regimes with respect to the end-of-life nature of medical assistance in dying, which is the reasonable foreseeability of natural death criterion, in particular, at the national level.

I will agree with some of the members we have heard from today that this is perhaps the most important issue we have faced in the last five years of this Parliament, both in the last Parliament and today. Fine-tuning the approach to medical assistance in dying is something that is intensely personal, but also intensely important to all of us in the chamber and to all Canadians.

What we should know at the outset is that the court's ruling in Truchon applies only in Quebec. We heard the minister speak about this. The court suspended its declaration of invalidity for a period of six months, until March 11.

It is important for this chamber to recall that on February 17 of this year, the Attorney General of Canada filed a motion to request an extension to give Parliament sufficient time to enact an appropriate response to ensure consistency in the criminal law. Given the circumstances of COVID and the pandemic, an extension was further sought and granted in June until December 18 of this year. Therefore, December 18 is the new deadline.

Before I go into some of the details in the bill, I want to start out with two important provisions that relate to conscience protection. This was raised in today's debate and was also raised in the context of an earlier debate on this bill in a previous parliamentary session. I think it is critical the record be crystal clear that conscience protections are robust in this country and are entrenched in law.

I am responding here to questions that were raised by the member for Sherwood Park—Fort Saskatchewan. The first location for conscience protections is in the preamble to the old bill, Bill C-14, which states, “Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms”.

I have had further questions from members of the official opposition about why it is only in the preamble and not in the statute. That assertion is categorically incorrect, because conscience protections are in the statute itself. Section 9, page 8, of Bill C-14, which amended the Criminal Code, states, “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

Lastly, the third point I will refer to is from the Carter decision of the Supreme Court, which has been the subject of extensive discussion in this chamber thus far. I am reading from paragraph 132 of the majority reasons in Carter. The court states, “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

Those are the three instances where the freedoms set out in section 2 of the charter are taken into account. One is jurisprudential and the other two are statutory. The fourth one is of course section 2 of the charter, which protects freedom of conscience for all Canadians, including those who practice medicine. Therefore, the assertion that somehow conscience rights are not protected or are somehow being eroded is categorically false.

Another point on what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us. Here I am referencing some of the interventions made again by the official opposition, particularly the member for Sarnia—Lambton, that somehow this government bill is pushing us further toward predatory practices by health care practitioners or toward disavowing the right to life, liberty and the security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in the evidence.

The evidence that we have is that, in total, nearly 14,000 medical assistance in dying deaths have happened in the country in the last four years. The average age of the people accessing MAID is 75 years old. It is being accessed equally by men and women, 51% of the time by men and 49% of the time by women. The most common medical condition is cancer, followed by neurological conditions. In that 67% of all people who access it have cancer; second, come neurological conditions; and third, come cardiovascular conditions.

Very important, in the most recent year of analysis, a grand total of 5,444 people accessed MAID in this country. That represents 1.89% of all deaths in the country. I am saying that specifically for the purposes of the debate, because it is important for Canadians to understand that there is not some sort of culture of medical assistance in dying that is being foisted upon unwitting individuals. I will elaborate upon this going forward.

I would like to address a few aspects of this bill. The eligibility criteria have changed, as the Minister of Justice mentioned this morning.

There are two sets of safeguards. One applies when the individual's death is reasonably foreseeable, while the other applies when it is not. The bill adds new safeguards for this second category.

The bill proposes allowing final consent to be waived on the day of the procedure in exceptional circumstances.

Earlier in the year, the minister, along with the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion, as well as myself and other parliamentary secretaries, conducted a very vast consultation process. We heard from 125 individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, from nurses, doctors, etc. We also heard from 300,000 Canadians through their responses to a questionnaire that outlined various scenarios.

The views of those individuals were quite concrete in the direction they were seeking. They wanted to be empowered in terms of their autonomy, dignity and their choices. They were seeking fewer obstacles to what had evolved to become an overly restrictive regime, as identified by the court in Truchon. That important feature must be canvassed here. What is important to understand is that the input received was critical to the development of the bill.

As part of the proposed amendments to the Criminal Code, the reasonably foreseeable death provision will be removed from the eligibility criteria. This is in response to the Truchon decision.

In terms of legal impact, this amendment would mean that people whose death is not reasonably foreseeable would be eligible for medical assistance in dying if they meet all of the other eligibility criteria.

This point is very important. The bill proposes to exclude persons whose sole underlying condition is mental illness. This has been touched upon by different people who have already intervened in the context of today's debate and in previous debates in the previous session of Parliament. This is important, as was outlined by the minister this morning. It recognizes the increased complexities and risks associated with such cases, which were highlighted by many practitioners, stakeholders and experts at the main round tables.

What is also very important is that the Canadian Mental Health Association supports the position we are taking with respect to excluding mental illness as a sole underlying condition. This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying.

Importantly, the Government of Québec has also announced the exact same study for the exact same provision in the context of mental illness. Issues of consent and capacity and properly being able to diagnose this and having a prognosis are critical.

I will move to some of the comments that have been made. It is important for people to understand the safeguards are under two tracks. Those safeguards respond to persons whose deaths are reasonably foreseeable and those whose death is not.

With respect to some of the aspects raised in the context of today's debate, please understand we have taken the 10-day period of reflection out of the legislation. The basis for this was that the safeguard was not doing the work it was meant to do. As opposed to protecting those who were vulnerable, it was increasing vulnerability insofar as it was prolonging suffering.

We have heard some people were so concerned about their inability to provide their final consent after 10 days that they would stop taking their pain medication, which was simply creating further suffering just to maintain the ability to provide final consent.

With respect to how we can ensure informed consent is applied when it has not been solicited actively, there are two responses. This is with regard to the advanced consent regime.

The government is conscious of the Audrey Parker situation and we are seized with it. When people have been assessed and approved for this procedure and when they make a determination they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to whether it could be vitiated, yes it could. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that could be interpreted to fully and finally eliminate that consent for the purposes of the practitioners. That is in response to a question posed by the member for St. Albert—Edmonton.

This bill strikes a balance and the balance is important, a compassionate response that protects vulnerable people, respects their dignity and autonomy and what is required by the Constitution. I am very hopeful we can achieve all-party consensus on this fundamental issue.

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

Madam Speaker, I would like to talk a bit more about the conscience protections. The hon. member mentioned it was in the preamble, in section 9 and in the charter. Why then does the government not immediately address the situation existing in Ontario, where physicians and nurses are being forced to participate in MAID even if it is against their religious beliefs?