Madam Speaker, I am pleased to participate in the discussion on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
I have the privilege of being a member of the House of Commons Standing Committee on Justice and Human Rights. The committee heard from quite a few eminent witnesses during its examination of the bill. Their testimony before the committee gave rise to a number of reasoned amendments that were the subject of a lively debate among committee members.
I would like to take this opportunity to give members of the House an overview of the committee's work on Bill C-7 because I believe it could help inform upcoming discussions on this important legislative measure.
Before I do that, I want to emphasize to members of this place the looming court-imposed deadline to pass this legislation by December 18. It is important that we move expeditiously on this piece of legislation to ensure we do not prolong the suffering of Canadians or create an uneven law in respect of medical assistance in dying across the country.
The most important change put forward by Bill C-7 is its repeal of the reasonable foreseeability of natural death criterion in response to the decision in Truchon. The committee heard from several disability organizations and individuals living with disabilities who shared powerful testimony about autonomy, what it means to make a truly informed and voluntary choice, and the inherent dangers they perceive in shifting Canada's MAID regime away from an end-of-life one toward one that, in their words, made disability a justification to end life.
I want to discuss some of the amendments that were not adopted. This is an important piece of legislation and a very challenging issue, and we faced some difficult questions at committee. The majority of the members at committee ultimately felt confident that the current eligibility criteria in the MAID provisions adequately protect Canadians. There is a requirement that for people to be eligible for medical assistance in dying, their suffering must either be due to illness, disease or disability, or an advanced state of decline in capability. Suffering that would be solely due to factors like a lack of supports or the experience of inequality would not make a person eligible for MAID.
Of course, people can experience intolerable suffering for different reasons, and that brings me to the eligibility criteria that will apply in all cases and how they protect people.
Individuals are eligible for medical assistance in dying only if they make a voluntary request that is not coerced and give informed consent. We are confident that these criteria, combined with the judgment of practitioners who assesses eligibility for medical assistance in dying, will address those concerns.
The committee also studied the two-track system proposed in Bill C-7, paying special attention to the fact that reasonably foreseeable natural death will no longer be one of the eligibility criteria, but the factor that determines which set of safeguards applies in a given case.
The committee examined the possibility of defining this criterion as meaning a person would have 12 months or less to live. The phrase “reasonably foreseeable natural death” requires a connection to death that is temporal but remains flexible. To some members and witnesses, that flexibility sacrifices certainty, which can make the job of practitioners more difficult. This concern is what prompted the suggestion that we define it as requiring a prognosis of 12 months.
The majority of the committee members chose not to adopt that amendment, as we believe practitioners are able to continue to make determinations on the basis of the flexible criterion they have been using to date. That evaluation is determined on a case-by-case basis. The reasonably foreseeable natural death criterion does not have an arbitrary 12-month outer limit, so this proposed amendment would have narrowed its meaning.
The committee also discussed possible amendments to maintain the 10-day reflection period for people whose death is reasonably foreseeable, which is what we are talking about today, to reduce that period to seven days and to maintain the safeguard requiring two independent witnesses.
In the end, those amendments to Bill C-7 were not adopted. I think that is the right decision because I feel that changes to the existing safeguards are in line with feedback we got from practitioners across the country who participated in the January 2020 consultations. A number of the witnesses who appeared before the Standing Committee on Justice and Human Rights reiterated that.
I do not think these changes will cause any harm or make the process any less safe for those whose death is reasonably foreseeable. We do believe that these changes will alleviate suffering.
The committee also discussed amendments that would have lengthened the assessment period when death is not reasonably foreseeable to 120 days, and transformed it into a reflection period. The majority of the committee members did not accept these amendments, as we feel they would have prolonged suffering for those whose deaths are not reasonably foreseeable, without necessarily improving the safety of the regime.
The 90-day period is meant to be an assessment period, not a reflection period. I have already mentioned that in the course of today's debate. During that assessment period, practitioners evaluate eligibility, canvass other options for relieving a person's suffering and discuss these options with the person in question. It is not intended to impose a minimum waiting period after a person is found to be eligible.
We believe that Bill C-7 strikes the right balance between safety and patient autonomy, particularly given that we are amending the Criminal Code, which sets out the minimum requirements for a practitioner to rely on exemptions to otherwise applicable criminal offences. A practitioner could always spend more time assessing a patient, if they believe it to be necessary in the given case, again, underscoring the individualized nature of the assessment.
The committee did adopt an amendment, which the member for Saanich—Gulf Islands just mentioned, which I think will improve the second track of safeguards for those whose deaths are not reasonably foreseeable.
As introduced, Bill C-7 required that one of the two assessors have expertise in the condition that is causing the person's suffering. The committee heard that this requirement could pose significant barriers to access since experts are rarely made assessors. While they may be willing to provide their expert advice in a case, they may not be willing to undertake the entirety of an assessment for a patient that they do not know and may feel their time is better spent delivering that expert care to others.
The amendment, moved by the NDP member for Esquimalt—Saanich—Sooke, would allow the assessors to consult an expert when neither of them has the relevant experience. We appreciate this evidence-based adjustment to the bill.
The committee also accepted an amendment proposed by the member for Nanaimo—Ladysmith. Here is the reference made by the member for Saanich—Gulf Islands. This amendment would require the Minister of Health, in carrying out her duties related to subsection 241.31(3), to consult, when appropriate, with the minister responsible for the status of persons with disabilities. These duties would include developing regulations in support of monitoring medical assistance in dying and establishing guidelines for the death certificate reporting of medically assisted deaths.
While I am confident that the current Minister of Health has been and would continue to do this in any event, I am very happy to see this enshrined in the legislative package to ensure that the voices of the disability community are heard in this process.
I want to thank my colleagues, including the members opposite, who participated in the justice committee for their thoughtful interventions and their thoughtful deliberations. I want to emphasize to my colleagues the importance of moving quickly on this legislation because of the court-imposed deadline by the Truchon decision.
I want to raise one point that has come up in the context of what was raised by the member for St. Albert—Edmonton. This was the idea that the proposed package actually perpetuates discrimination vis-à-vis persons with disabilities. The issue of disability discrimination was canvassed directly in the Truchon decision, and in that case the court said, and I will quote from paragraph 681:
...the challenged provision perhaps perpetuates another probably more pernicious stereotype: the inability to consent fully to medical assistance in dying. Yet the evidence amply establishes that Mr. Truchon is fully capable of exercising fundamental choices concerning his life and his death. As a consequence, he is deprived of the exercise of these choices essential to his dignity as a human being due to his personal characteristics that the challenged provision does not consider. He can neither commit suicide by a method of his own choosing nor legally request this assistance.
[682] Individuals in the same position as Mr. Truchon must be allowed to exercise full autonomy not only at the end of life, but also at any moment during their life, even if this means death, where the other eligibility conditions for medical assistance in dying are met.
[683] The Court thus concludes that s. 241.2(2)(d) of the Criminal Code clearly infringes the applicants’ right to equality.
Equality is critical here. The point I am making is that discrimination against persons with disabilities cannot be tolerated and should never be countenanced. The point that was made in the court and the point we are making on this side of the House is that in order to entrench equality, to fulfill the promise of the charter in section 15, we must empower persons with disabilities to make the exact same choices, give consent and exercise the same autonomy over their bodies as persons who are not disabled. That is what the court drove at in the Truchon decision. That is what this bill reflects.