Madam Speaker, we are now at the third reading stage of C-7. This means all the amendments that will be considered by the House have now been considered, and we must now pronounce on the final version of the bill and its effects.
Before I speak about this bill in final form, I want to respond directly to what I see as the government's principal argument for this legislation and other similar legislation. It tells us this is all about choice: the choice of individuals to live as they choose and die as they choose. The idea is that moral judgments about good living and good dying ought to be made by the person doing the living and dying, as opposed to by someone else, because the individual is uniquely qualified to make judgments about their own happiness and someone outside their skin simply cannot make those judgments as well.
This is the one serious argument people use to advance this bill and others like it. We should of course appreciate the existence of other unserious arguments, such as the assertion that, “The courts told us to,” or, “This is what people we have consulted told us to do.”
A small part of this bill responds to a lower court decision, but most of it has been invented, out of thin air, by the government and whoever it consulted or did not consult. Over a thousand physicians have signed a letter opposing this bill, and every single disability rights organization that has spoken out about this bill has spoken in opposition to it. These are unserious arguments stemming from unserious readings of court decisions and unserious consultation.
The serious argument made in support of this bill, as I have stated, is that people ought to have the choice to make decisions about their living and dying because they know what will lead to their happiness better than anyone else. This is the argument, but we should also notice how those who use this argument ultimately choose to apply it selectively. Even while suggesting it is all about choice, they insist on changing the words we use to describe the choice in order to make us feel better about it.
The phrase “medical assistance in dying” was invented at the time Bill C-14 was proposed, and is not a phrase used in other countries to describe the phenomenon of doctors killing their patients. If this is really about choice, why do we have to invent new pseudo-terms to make ourselves feel better about that choice?
If I asked members point blank whether they think a person should be able to commit suicide, I am sure many would respond that this is not suicide. It is completely different, as it is medical assistance in dying. Formally, what is meant by medical assistance in dying is facilitated suicide, or killing in a medical context. We claim to be focused on choice, but we still are uncomfortable enough with the choice that we have to invent new words to describe it.
Some members do not like the use of the word “euthanasia” to describe the phenomenon of doctors and nurses killing their patients after being asked to do so. The Minister of Health told the Standing Committee on Justice and Human Rights that phrases “referring to this bill as 'euthanasia' legislation, which I have heard in the House of Commons, are incredibly demeaning to the dignity of people”.
The health minister may be interested to know the word euthanasia actually comes from two Greek words: “eu”, meaning well, and “thanatos”, meaning death. The term euthanasia means “good death”, and is itself a sanitization of the concept of killing. If the term is misleading, it is not because it is too harsh but because it is too gentle. As we have heard, not all cases of assisted suicide can reasonably be called good deaths by any definition.
Notice that the word euthanasia is never used to describe the administration of the death penalty. The term was invented in order to sanitize the idea of the medicalized killing of a consenting person. It is instructive that a sanitized term for this practice, once people had a full social awareness of its meaning and reality, had to be replaced by a new sanitized term to further obscure the true nature of what is taking place.
No doubt, in 20 or 30 years, the term MAID will be thought gauche and replaced with another, more up-to-date sanitization of a term that no longer makes us feel better about something we naturally feel uncomfortable about. The point is that if this all about choice, and if we are comfortable with this choice, why are we not comfortable speaking plainly about sick people committing suicide and about doctors killing their patients when asked to do so? Would that not be a more plain and accurate description of the choice that many wish to defend?
If there is a practice or activity that people are uncomfortable seeing depicted or hearing described accurately, perhaps we should ask ourselves why we feel uncomfortable instead of demanding that the images and descriptions be put aside.
Members should observe as well that the idea of a choice to die, or a right to die, is being advocated for selectively. Some people have a right to die and some people do not, apparently, so we have to ask why this principle is being selectively applied.
Suppose that I, an able-bodied healthy white man, experienced some great personal tragedy such as the death of a child or the breakup of my marriage. It is possible that following such an event I might start to experience extreme existential pain and suicidal ideation. If I then went to a doctor to share the feelings I was experiencing, I would not be presented with MAID as a way out of the challenges I was facing. The way I look, my health status and other characteristics I have would signal to the doctor that my life was worth living. We know it to be true that when a young, able-bodied person chooses to die, those around them will say, “What a tragedy. He had so much to live for.”
The argument for a choice to die does not apply to those who society believes should not choose to die, even if such people are sincere in their expression of pain, in their sense that their pain is irremediable and in their desire not to continue living, but what of a person who is older, who is disabled, who does not fit the stereotypical social mould of someone who has a lot to live for, presents themself to the health care system experiencing existential pain and suicidal ideation?
We know from testimony from the justice committee that people in this situation are offered and even pressured to opt for MAID. People who are elderly or living with disabilities are often offered and pushed to take MAID without asking for it. This is the testimony given over and over again at the justice committee and confirmed by the minister responsible for disability inclusion, who acknowledged how concerned she is about people with disabilities being regularly and proactively offered MAID that they do not want.
We see here an important and revealing contradiction in the application of the principle of choice. For some in society, death is seen as an unreasonable choice and is actively discouraged. For others, death is seen as a desirable choice and is actively encouraged. This is not just a debate about choice, therefore. Rather, it is a debate about how the architecture of choice is set up differently for different people, based on whether others assess their lives as being worth living.
This is what leaders in the disability community are deeply concerned about: how this legislation includes them and only them in the additional category of those for whom we think death is a reasonable course of action.
Suppose that of my four children one had a disability and suppose that I taught three of my children to always press on because life is beautiful, but I told the fourth child that they should consider death if they ever faced circumstance that they could not handle. Do colleagues think that situation would make my fourth child feel privileged by the special offer of choice or do colleagues think she would feel devalued by the fact that I thought death was uniquely an option for her, based on the presumption that her life was not worth living?
Choices do not exist in a social vacuum. When we speak about choice, we recognize that people are making choices between available options and the nature of those available options is constructed by the society in which they live.
I used to think that people were always better off with more options, that just like a menu at a restaurant, we are always better off with more options available to us: the longer the menu, the better. If I do not like any of the new options available, then no problem. I do not have to choose them, but I should not begrudge other people the opportunity to have more choices available to them, even if I do not like those choices. Nobody is made worse off by the lengthening of the menu. Then I realized that it was not that simple. If I am in a restaurant and the only options available are chicken or beef then, arguably, yes, I am better off with the addition of more items on the menu; a fish option, a vegetarian dish, etc., but there is also a case in which the existence of certain options on the menu fundamentally changes the nature of the experience.
Suppose that while travelling, I encounter a restaurant that offers a human flesh sandwich in addition to the usual fare. It is fairly safe that I would not stay and order in that restaurant even if I had no intention of ordering the human flesh sandwich. It is unlikely that any members of this House would feel comfortable eating in such a restaurant, even if all they planned to eat was the filet mignon. That example illustrates the way that the offer of an additional option can actually change one's entire experience of a place or environment. A person with a disability who is offered death has a very different experience of health care from a person who is consistently offered life-affirming care.
The fact that people are offered or encouraged toward certain choices, and that some people are offered those choices and others are not, changes the entire experience of health care for many people. Part of the response to this brave new world of so-called medical assistance in dying is that people are seeking safe spaces where they can receive care that is life-affirming. There are still many people in this country who have about as much interest in receiving care in an environment where death is being offered as they do in eating at a restaurant where cannibalism is offered. Such people should be free to receive care in a hospice where life is the only choice and where they feel safe from the possibility of pressure of a momentary weakness or from the sense that they are an unnecessary burden. Some are still looking for care that is animated by the conviction that all lives are always worth living, but perversely, those who claim to champion choice are actually attacking these safe spaces. With the absence of conscience protection in this or any other legislation like it, doctors are being forced out of their profession and life-affirming hospice care is being shut down.
We wonder why we have a crisis in long-term care in this country. Maybe it has something to do with the fact that so many of the people in organizations that have historically operated in this space are being pushed out because of a lack of conscience protection. Protecting the conscience rights of physicians and institutions is not just about the rights of providers. It is about the right, indeed the choice, of patients to receive care in a certain kind of environment if that is their desire.
I know from the many conversations that I have had with constituents, including those who are very supportive of the expansion of MAID, that the present realities of the social architecture of choice are top of mind for them during their advocacy. In other words, they want more euthanasia because they find the alternative intolerable. An absence of good care, an absence of effective pain management, an absence of support to live in a way that accords with their sense of dignity and a sense of resignation about these realities leaves them to want to be able to end it all, rather than endure under undesirable conditions, but those conditions could themselves be changed. The expansion of euthanasia, along with continuing pressure on all health care institutions to offer it, will further erode the life-affirming nature of care that people receive.
I remember once having a long conversation with a constituent who explained to me her reasons for advocating for expanded euthanasia. She emphasized the classic arguments about choice and control, and then shared with me a story of being in a care situation and struggling to have a bowel movement unaided. She went to the nursing station for help, and unfortunately was met with a gruff and unempathetic response. Her memory of the sense of indignity she felt, struggling for a long time on her own, and then seeking the help of a person who seemed uncaring and disgusted, was clearly a part of her thought process about the circumstances under which she would want to die.
While I can identify with her feelings in the moment, I think the solution is to give people the choice of compassionate care. It is a tragedy that people are considering death because of moments of perceived indignity that can be quite directly resolved.
Many older people who are considering death say that they do not want to be a burden on others. This is expressed as a matter of choice, but it is also revealing about the architecture of choice. It is generally unheard of for children to insist on paying rent to their parents or living independently because they do not want to be a burden. Certainly, I have never heard such sentiments from my children.
Why are elderly people made to feel like they might be a burden, while children are not? Again, this is an issue of social context. If children were constantly told from a young age that they were a great burden to their parents, that they were costing them money that could be spent on other things, and that they were interrupting their social lives, then children would likely start to worry about being a burden.
Conversely, if seniors and people with disabilities were constantly affirmed for their value and their ability to contribute to society, constantly told that they hold the key to our future rather than constantly being told about the burden they impose, then of course they would be more likely to choose life instead of death.
This is not just a question of choice. It is a question of the social architecture of choice that leads people to make different choices in different kinds of situations based on the limited options in front of them and based on the way that different options impact each other.
To underline this with one further point, it should not escape the notice of members that the government's Bill C-6, the proposed ban on conversion therapy, is built on the premise that people cannot consent to something that is contrary to their human dignity. Although I have concerns about the text of Bill C-6 as written, I agree with the principle that conversion therapy is wrong and should not be allowed.
In light of both Bill C-6 and Bill C-7, it remains unclear to me what the government's view is on the ability of a person to consent to harm. Is it the view of the government that people should be able to voluntarily consent to things that harm them? Looking at these bills together, we might conclude the government finds it okay for people to consent to death but not okay for people to consent to certain things that are deemed worse than death. However, this subjective categorization of certain harms as being worse than others clearly may contradict an individual's own subjective sense of what things are more harmful than others.
It is time for us, as parliamentarians, to talk about the choices that elderly people and people living with disabilities have in front of them, and to give them options besides death, to move from a narrow focus on questions of choice to a discussion of the architecture of choice that puts people in impossible and painful situations. A good society is not just one that gives people the formal right to make choices between different alternatives. It is one that ensures that those alternatives are sufficiently robust so that individuals are able to make choices that truly lead to happiness. Of course not all choices lead to happiness.
People can make choices that they think will lead to happiness, but do not. This is especially serious when a decision is final and irreversible. The wider community has a reasonable interest in ensuring that a person making that choice has at least all of the information in front of them, taking into consideration the fact that people can and often do adapt to new circumstances over time. A belief in the pursuit of happiness entails a belief in freedom but also a belief in the value of encouraging the considered use of freedom through due reflection.
Having reflected on the application of the concept of choice in this context, I would now like to make a few additional comments about the provisions of this bill and the timing of it. This bill proposes to eliminate the requirement that death be reasonably foreseeable for those seeking euthanasia and puts those for whom death is not reasonably foreseeable on a second track with some distinct requirements. The reconsideration of the question of reasonable foreseeability was provoked by a court decision in Quebec, the Truchon decision, which the government could have chosen to appeal but did not.
This bill deals with more than this question. It also arbitrarily eliminates a number of safeguards that have nothing to do with the Truchon decision. It eliminates the 10-day reflection period. It reduces the required number of witnesses. It eliminates the requirement for contemporaneous consent. The removal of the 10-day reflection period in particular has led experts to point out that this opens the door to same-day death, to a situation where a patient could request and receive euthanasia on the same day.
Some members of this House have strenuously objected to the use of this term. Same-day death is a jarring idea that someone's worst day could be their last, and that temporary suicidal ideation could lead to immediate death. However, those who find this term uncomfortable must face up to the fact that the legislation as written contains no parameters for those for whom death is deemed reasonably foreseeable.
If members believe that time parameters exist, then they should point to where they exist in law. If members believe that time parameters should exist, then they should have supported their reintroduction into the bill. As the law stands before us now, there are no legislated requirements around timelines for those for whom death is reasonably foreseeable.
At third reading, members must choose whether or not they will vote for same-day death in Canada. As Wilberforce said:
You may choose to look the other way but you can never say again that you did not know.
The Conservatives have proposed reasonable amendments to reintroduce the reflection period, introduce a shorter reflection period and reintroduce requirements around contemporaneous consent and independent witnesses, in particular, recognizing the different experiences people with disabilities have reported with respect to the health care system. We also introduced a requirement that health care practitioners only discuss euthanasia if it is brought up by the patient first. These safeguards matter and would protect vulnerable people by reducing their risk of being rushed and pressured into vulnerable situations.
In response to our call for safeguards, the government said it trusts health care practitioners and these rules are not required. The purpose of a safeguard is not to respond to what may be the average case, but to establish a minimum standard. We are talking about 100,000 people in this country whose professional qualifications would allow them to administer euthanasia. Are those 100,000 so uniquely virtuous or trustworthy they do not need laws to regulate their behaviour while the rest of us do? I believe most people in medicine are doing their best to selflessly serve others, but one needs only listen to the testimony at the justice committee to realize some of those who are providing health care have fallen short of that call. All of us need laws to regulate our behaviour to some extent. If we need regulations, then how can we expect those 100,000 people to be different? Are there no bad apples? I am not arguing they should be subject to unique suspicion, but that they simply need rules and laws to guide their actions like the rest of us do. People charged with taking another person's life should do so within strictly defined parameters for their own good and that of everyone else. I trust doctors just as I trust police officers, but they still need regulations and oversight. We recognize there are some bad apples on our police forces and if we need safeguards for police officers in light of their power to take life, then we also need safeguards for those in power to take life in a medical context.
The government has been working very hard to push the narrative about timing, claiming the Conservatives are responsible for delaying this bill. It should stand to reason that if the government wants us to invest in rapidly passing its bill, it must proceed to persuade us that it is a good bill, which it has not done. The Truchon decision requires a response, but matters would be much simpler if the bill only focused on a response to Truchon instead of a variety of other changes. As it is, we are forced to consider all of the elements together, not just the narrow part that responds to Truchon. This is the government's choice, not ours.
Let us also take stock of how we have come so close to the court deadline. This legislation was presented in February. In May and June, the Conservatives wanted the House to sit in a modified form, but the government refused to allow it. Then it killed its own bill by proroguing in August. All of these moves pushed us into the mid-fall before the bill was considered. It then received a mere four meetings of witness testimony at the justice committee. The government's approach to this legislation has been to delay until the last minute and then demand urgency instead of a considered review. Let us be clear that this is a political tactic designed to subject these radical changes to as little debate as possible.
As a high school student, I had the honour of participating in a special MLA for a Day program at the Alberta legislature. At one of our meetings, a seasoned Progressive Conservative minister explained to us how legislation was passed. Students were surprised by the length and complexity of the process. They asked why it took so long and could the process not be shortened a bit. The minister told us he was glad it took so long because one of the fastest pieces of legislation to ever pass in the Alberta legislature was the Sexual Sterilization Act of 1928, which allowed the government to sterilize people with disabilities against their will based on the analysis that they imposed an undue burden on society. Legislators at that time should have taken more time to listen to people with disabilities and considered the implications of what they were doing. The point that when we are in too much of a hurry to make decisions we risk undermining the fundamental rights of our fellow human beings, in particular, those living with disabilities, has stuck with me to this day.
Those of us on this side of the House who are raising concerns and demanding that time be taken to consider this bill and appropriate safeguards be put in place are on the right side of history. As was the case with the Sexual Sterilization Act of 1928, when this bill is repealed in five or 50 years, I will proudly tell my grandchildren that I took a stand for the universal immutable dignity of every human being.