Debates of Feb. 26th, 2020

Criminal Code

[David Lametti, Liberal, Minister of Justice]

moved 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.

Madam Speaker, I am pleased to rise today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

The bill proposes a legislative response to the Superior Court of Quebec's Truchon decision, as well as some other changes to the Criminal Code provisions that set out Canada's medical assistance in dying regime.

In June 2016, former Bill C-14 amended the Criminal Code to create Canada's first law on medical assistance in dying, or MAID. The legislation created exemptions to Criminal Code offences so that individuals suffering unbearably and nearing the end of their lives could die peacefully and with the help of a physician or nurse practitioner, rather than in agony or in circumstances that they considered undignified.

This significant change in our criminal law was indicative of the value that Canadians ascribed to having choices, including about the manner and timing of their deaths when suffering in the dying process was intolerable. The most recent data obtained by the federal MAID-monitoring regime indicates that over 13,000 Canadians have received MAID since it has become decriminalized.

We are now proposing another important change to our criminal law. In Truchon and Gladu, the Quebec Superior Court ruled that it was unconstitutional to limit access to medical assistance in dying to persons whose death is reasonably foreseeable.

We decided not to appeal the decision because we want to reduce the suffering of people waiting for medical assistance in dying.

When we announced our decision not to appeal the ruling, our government also committed to changing the eligibility criteria for medical assistance in dying throughout Canada to ensure that criminal law is consistent nationwide.

Application of the court's ruling, which is limited to Quebec, was suspended for six months. The deadline is March 12. Because these issues are so important and because we want to ensure that our laws are consistent all across Canada, we have asked the court for a four-month extension, which would give Parliament time to thoroughly consider and debate the amendments proposed in this bill. There was a hearing yesterday regarding this request.

Consulting Canadians about the next phase of medical assistance in dying in Canada was crucial to drafting this bill. That is why we launched a two-week public consultation on January 13. The level of participation was unprecedented. We received over 300,000 responses, an indication of how important this issue is to Canadians.

At the same time, together with the Minister of Health, the Minister of Employment, Workforce Development and Disability Inclusion and our parliamentary secretaries, we held 10 round-table discussions across the country between January 13 and February 3.

This included round tables in Halifax, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Calgary and Vancouver. We met over 125 individuals, including doctors, nurse practitioners, legal experts, members of the disability community, indigenous peoples, and representatives of health regulatory bodies and civil organizations.

We are grateful to all who participated in the round tables. Their shared expertise and experiences were of immense value in developing this bill. I have no doubt that many will continue to engage in the parliamentary process as witnesses before committees.

The results of this consultation process will be published shortly in a “what we heard” report. We heard views on many different topics, but I would like to mention just a few.

From the public online consultations we heard that, while the majority of respondents think the current safeguards are adequate to prevent abuse, in a MAID regime that is expanded to persons who are not dying in the near term, a majority of respondents also thought it would be important to require additional safeguards in such a broader regime. Many round-table participants suggested two separate sets of safeguards in an expanded regime. Others shared their experiences with existing safeguards as they apply to those who are near the end of their lives.

Specifically, many felt that the requirement for two witnesses when a person's written request was made was too onerous and afforded little protection, and that the 10-day reflection period unnecessarily prolonged suffering.

Informed by these in-depth consultations, and by the Canadian experience with medical assistance in dying to date, along with many other sources of information, Bill C-7 proposes to respond to the Truchon decision by adjusting both the eligibility requirements and the safeguards. It also proposes to enable patients in certain circumstances to waive the requirement for final consent so that they do not lose their access to MAID.

We know there are other issues about which many Canadians still feel strongly but which are not subject to the Superior Court of Québec's deadline, such as eligibility in cases where mental illness is the sole underlying condition, advanced requests and mature minors. These will be examined in the course of the upcoming parliamentary review.

Before describing the proposed amendments, I would like to address the concerns we heard from many in the disability community following the Truchon decision and during our consultations. Disability groups were very clear that, for them, removing the end-of-life limit on MAID would create a law that holds disability as a valid reason for ending a life and reinforces the false perception that disability is equivalent to a life of suffering.

Our government is sensitive to these concerns. We strongly support the equality of all Canadians, no matter their situation, and we categorically reject the idea that living with a disability is a fate worse than death. However, we are also mindful of the need to balance these concerns, along with others that have been expressed, with other important interests and societal values, in particular the importance of individual choice.

The bill's objectives are therefore to recognize the autonomy of individuals to choose MAID as a means of relieving intolerable suffering, regardless of their proximity to natural death, while at the same time protecting vulnerable persons, recognizing that suicide is an important public health issue and affirming the inherent and equal value of every person's life. More concretely, Bill C-7 proposes to expand eligibility for medical assistance in dying beyond the end-of-life context by repealing the eligibility criteria requiring that natural death be reasonably foreseeable.

Recognizing that intolerable suffering also arises outside of the end-of-life context and that Canadians want to have choices, medical assistance in dying would be become available to all those who are intolerably suffering; who have a serious and incurable illness, disease or disability; and who are in an advanced state of irreversible decline in capability, without regard to whether they are dying in the short term.

At this time, the bill proposes that persons whose sole underlying condition is a mental illness not be eligible for medical assistance in dying. First, we are subject to a court-imposed deadline and this matter requires more in-depth review and debate. We have learned that the trajectory of a mental illness is more difficult to predict than that of most physical illnesses. This means that there is a greater risk of providing medical assistance in dying to people whose condition could improve.

It is also more difficult to carry out competency assessments for individuals with a mental illness. In the case of some mental illnesses, the desire to die is itself a symptom of the illness, which makes it particularly difficult to determine whether the individual's request is truly voluntary.

Like the Government of Quebec, we are of the opinion that we need to continue consultations, discussions and policy development on the issue of MAID requests based solely on mental illness.

The parliamentary review that will be launched next June will be an appropriate forum for examining these issues, without the time constraints of the court-imposed deadline.

I would now like to turn my remarks to the question of safeguards. Many experts believe there are greater risks in assessing requests for MAID from individuals who are not nearing the end of their life. We agree. While these individuals would have a choice to seek MAID, the bill proposes that these requests be treated with greater sensitivity and care.

Accordingly, the bill proposes two streams, or two sets of safeguards. To distinguish these cases the bill proposes to use the concept of reasonably foreseeable natural death. Let me be clear on this point. Not having a reasonably foreseeable death would no longer be grounds for rejecting a MAID request; however, it would be used to determine which of the two sets of safeguards are required in a given case.

As enacted by Parliament in 2016, reasonable foreseeability of natural death refers to a death that is expected in the relative near term. It means that in light of all the person's medical circumstances, his or her death is expected in a relatively short period of time. Natural death is not reasonably foreseeable just because an individual is diagnosed with a condition that will eventually cause death many years or decades into the future.

In practice we know that practitioners are more comfortable prognosticating when death is expected in shorter time frames. The standard of reasonably foreseeable natural death provides flexibility in a way that maximum fixed prognosis would not. The standard also has the advantage of using language that practitioners have become familiar with over the last four years.

Those who are dying in the short or near term would benefit from the current set of safeguards in the Criminal Code, which the bill proposes to change in two ways.

First, the 10-day reflection period would be eliminated. We heard during the consultations that most persons have already given their MAID request a lot of thought by the time they sign their written request, resulting in the reflection period unnecessarily prolonging suffering.

Second, the requirement for two independent witnesses would be amended so that only one independent witness to the written MAID request is required. Further, we have added an exception so that health care and personal care workers who are not the person's provider or assessor would now be able to act as an independent witness.

Again, we heard that it is difficult for some who live in long-term care facilities or in remote areas to locate two independent witnesses. The purpose of the independent witness is simply to verify the identity of the person signing the request. The witness is not involved in the assessment process.

For persons whose death is not reasonably foreseeable, the existing safeguards would all apply with some additional ones. Specifically, the bill proposes a minimum 90-day assessment period, which will help ensure that practitioners spend sufficient time exploring the various dimensions of the person's MAID request, which, outside the end-of-life context, could be motivated by different sources of suffering requiring greater attention.

Also, at least one of the practitioners assessing eligibility would have to have expertise in the condition that is causing the person's intolerable suffering. The safeguard aims to prevent people from obtaining MAID when something could have been done to relieve their suffering or improve their condition.

The bill would also clarify the notion of informed consent for these kinds of cases.

First, a person who is not dying would have to be informed of the means available to relieve suffering, including counselling services, mental health and disability support services, community services, and palliative care, and be offered consultations with professionals that provide these services.

Second, the practitioners and the person would also have to agree that these means of relieving their suffering were discussed and seriously considered.

The bill also proposes to allow people whose death is reasonably foreseeable and who are eligible for medical assistance in dying to give prior consent if they risk losing capacity to consent before the date set for MAID. At present, the Criminal Code requires the practitioner to ensure, immediately before MAID is provided, that the person gives express consent to receiving MAID.

The bill would enable a patient who has already been assessed and approved to enter into an advance consent arrangement with their physician that sets out all the relevant details, including the date selected for the provision of MAID and the fact that the person consents to receiving MAID in case they lose the capacity to consent by the day in question.

Although this scenario was not covered in Truchon, experts told the government that it presents relatively little complexity and risk. Doctors also told us they would be comfortable with the idea of providing MAID under such circumstances.

To our government, compassion means ensuring that people waiting for MAID do not lose their opportunity to die in the manner or on the date of their choosing just because their medical condition robs them of the capacity to make decisions in their final days.

Another narrow form of advance consent would also be allowed in the unlikely event that complications arise after a person who has been assessed and approved self-administers a substance intended to cause their death and loses the capacity to consent to MAID, but does not die.

The patient and their physician could enter into an arrangement in advance, stipulating that the physician would be present at the time the patient self-administers the substance and would administer a substance to cause the patient's death in case the patient loses their capacity but does not die.

The data show that there have been very few cases of self-administration so far, perhaps due to fears of possible complications stemming from self-administration of a substance. Offering such an option could provide greater reassurance and allow more Canadians to choose this form of medical assistance in dying.

There are other changes in the bill that my colleagues will speak to, including changes to enhanced data collection and the monitoring regime that brings accountability and transparency to the practice of MAID in Canada.

A transitional provision would ensure that patients who have already signed their request when the bill comes into force would not be required to undergo any additional safeguards set out in the bill. At the same time, they would be able to benefit from the safeguards that would be eased, such as the elimination of the 10-day reflection period and the possibility of preparing an advance consent arrangement if it applies to that person's situation. We are committed to making the process as easy on patients as possible.

I would also like to briefly discuss the constitutionality of the bill. I have examined the bill as required by the Department of Justice Act. This involved consideration of the objectives and features of the bill. I am confident that the bill responds to the Truchon ruling in a way that respects the charter.

As is required by the Department of Justice Act, I will table a charter statement in the near future, which will lay out some of the key considerations that informed the review of the bill for inconsistency with the charter. This will serve to better inform parliamentary debate on this important piece of legislation.

I will conclude by thanking all those who participated in the consultations on medical assistance in dying and who contributed to the drafting of this bill. Bill C-7's proposed amendments to Canada's medical assistance in dying regime represent a fundamental policy shift, with the regime becoming less about end-of-life care and more about autonomy and alleviating intolerable suffering.

I look forward to working with all members of both chambers to ensure Bill C-7 is passed.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Madam Speaker, from my perspective, the elimination of certain stages dramatically changes the potential context for a person receiving euthanasia or assisted suicide.

Right now, the requirements to have a couple of independent witnesses and a little waiting period address the possible risk related to somebody who, for a few hours or a relatively short period of time, feels in the depths of despair and then recovers. The idea of the existing safeguards is to ensure that a person is not pushed into this decision without family members around, without talking to anybody, as it can be the result of a thought process that could last for a relatively short period of time.

The minister knows that in certain circumstances the 10-day waiting period can be waived already. Why is the minister removing safeguards like additional witnesses and the 10-day waiting period, which occurs most of the time but not all the time? Why is he creating a situation in which people could, as a result of a relatively short-term sense of vulnerability and thought process, make a decision they might at any other time in their life not make?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his interest in this matter.

What we heard in consultation after consultation across Canada is that the two safeguards in the current legislation are not doing their job as safeguards. All they did was add intolerable suffering on the person.

The two independent witnesses are merely there to witness the identity of the person who asks for MAID. In the decision to seek MAID, the assessments are all done prior to that by the medical professionals involved and the patient. This is really just a pro forma step. Having two witnesses, particularly for older people in remote areas of Canada who perhaps do not have any family left, became an unbearable impediment.

The 10-day reflection period came after the decision to have MAID. What happened is that people would, in some cases, not take their pain medication in order to not lose the capacity to make a final decision 10 days later.

It was believed virtually unanimously, among the experts, patients and others, that we should remove these two impediments, because they simply were not acting as safeguards and were increasing suffering.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Madam Speaker, I would like to begin by saying that the Bloc Québécois supports the principle of this bill. It is a step in the right direction, especially since the bill repeals the provision that requires a person's natural death to be reasonably foreseeable in order for them to be eligible for medical assistance in dying.

I recently met one of my constituents, Caroline Parent, a woman in her 40s who seemed quite engaged and active. Ms. Parent told me that she feels trapped in her own body and hopeless about her life. That was a very powerful day. Her story was overwhelming. She told me that she had gotten to the point of planning a trip to Switzerland, where medical assistance in dying is accessible, and planned to return in the luggage hold. This was a harrowing story, and I am pleased to see that this bill is making some progress in this respect.

I do want to mention that the Bloc Québécois thinks the notion of advance consent should be considered. We are also wondering about the possibility of eliminating final consent in cases in which the person's death is not reasonably foreseeable, as is the case with degenerative diseases like Alzheimer's, for example.

What does the minister think about that?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank my hon. colleague for the question. Obviously that is a very important question. We asked questions like that on the online form and we also asked them during roundtables and consultation panels we hosted across Canada, including in Quebec City and Montreal.

What we heard is that there is still a lot of work to do. There is some public sympathy for such measures, but these are very complex issues. There are still some unknowns and situations in which doctors and nurses do not feel comfortable with the potential framework.

It is a question we will address during parliamentary review. Studies are under way. Quebec commissioned a study and we commissioned one from the Council of Canadian Academies. This question is one of the elements we will look at, but for now that is a step we are not prepared to recommend.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, I remember being in this place during the debate on Bill C-14 and reading through the Carter decision, which was very clear. There was also, of course, the important work that was done by the special joint committee of both the House and the other place.

When I was speaking to Bill C-14 in 2016, I knew the inclusion of the “reasonably foreseeable” aspect of the law was going to cause us problems, and here we are. I am sure the justice minister is feeling some closure, because he was one of four Liberals who voted against that bill. I am sure he is getting some satisfaction in revisiting this now.

I am pleased to report that the New Democrats support the bill in principle. However, we have a number of concerns, specifically with the assessment period for those whose natural death is not reasonably foreseeable but who are facing intolerable suffering. The bill sets up a period of 90 days. We have already heard from some physicians who have concerns with the fact that they have to tell patients to bear their illness and suffer for another 90 days.

Could the Minister of Justice inform the House on how the Liberals came up with that number? How did they determine that 90 days is the right amount of time?

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I thank the hon. member for his very kind comments and the general support of his party.

We decided to have two regimes in order to keep doctors and nurses on board who were familiar with the original regime and add the possibility for others. There is a different set of balances in the non-end-of-life scenario. We heard from people who see themselves as vulnerable or susceptible to influence, like people living with disabilities for example, at round tables and this was an existential question for them.

This is the assessment period; it is not a reflection period. We have eliminated all reflection periods. This is the period of time in which the doctor or the nurse practitioner is assessing the condition with the patient. There are other proactive things the doctor or nurse practitioner has to do. We wanted to give an adequate amount of time for reflection. Some jurisdictions have six months in this scenario. We shortened that. We wanted to give enough time for adequate reflection. With catastrophic injury, for example, the first reaction is often that a person would rather die, but with time, a very short period of time, and after assessing the possibilities for life, a person makes a different decision.

This is really just adding to the assessment period, making sure that there is adequate discussion, adequate informing of the possibilities and consideration of the possibilities, while still understanding that people are suffering intolerably. We understand that, but feel this is an appropriate period that is not too long. It is certainly not as long as some of the other examples.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, I remember that as we went through the very difficult discussions on Bill C-14, within the Catholic community in Guelph, to which I belong, there were a lot of concerns around advance directives and conscience rights and the protection of conscience rights within the Catholic community in particular. I remember that at the time I was asked a few times whether we were going down a slippery slope.

I want to be able to say to my community that we are looking to handle this legislation in a compassionate way that protects rights, but I would rather hear it from the minister so that I can take an authoritative comment on that back to my community.

[David Lametti, Liberal, LaSalle—Émard—Verdun, QC]

Madam Speaker, I too am a practising Catholic, so these kinds of questions are very important to me.

This is about choice and reducing suffering. These are choices that have already been made. The pun is not intended. The point in the first scenario, in the known scenario, the end-of-life scenario, is to ease restrictions that were not doing any work. In the non-end-of-life scenario, the point is, again, to make sure that informed choice happens. That is why we think we have struck the appropriate balance.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I would like to seek unanimous consent to split my time with the hon. member for Mission—Matsqui—Fraser Canyon.

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

Is that agreed?

[Some hon. members]

Agreed.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, it is a great pleasure today to rise as the shadow minister of justice for the official opposition to speak to the government's Bill C-7. As I rise to speak on this bill, I do so with concern over some of the contents within it and even over the way it was presented to the House this week when, unfortunately, many of us read about the contents of the bill in the media, rather than seeing it first in this House.

The bill was intended to be a response to the Quebec Superior Court decision that was made on September 11, 2019. The decision stated that the law as it stood was too restrictive around the requirement for death to be reasonably foreseeable. The official opposition called on the government at the time to appeal the decision to the Supreme Court of Canada in order for Parliament to receive clarity about the parameters in which we would legislate, but the bill was introduced without that clarity.

Not only was the bill introduced without that clarity, but it goes far beyond what was required to meet the Quebec Superior Court's decision. I believe that is an affront to this Parliament, because when the previous bill, Bill C-14, was passed in the 42nd Parliament, the wisdom of this Parliament required that there be a statutory review of our assisted dying regime in Canada. That statutory review was and is to take place in June of this year.

It is in that review period that parliamentarians would be able to go more into depth on how the government's legislation has worked over the past several years and on how best to proceed. Rather than wait for that review, as it should have done, the government has decided to start making amendments to the legislation now, avoiding the in-depth review that is to take place shortly.

The reality is that when we are talking about this legislation, we are literally talking about the matter of life and death. This is an incredibly sensitive issue. Members on all sides of the house have diverse opinions on it, and it is because of this diversity of opinions and because of the sensitivity of this issue that the Quebec Superior Court decision should have been appealed to the Supreme Court of Canada for further clarity. However, as the government has now opened this legislation up, it is upon us as legislators to now highlight other matters that should be addressed and included.

My office has heard plenty from concerned Canadians about the lack of protection for conscience rights for health care professionals. This is particularly important now that the government is broadening medical assistance in dying to include individuals whose death is not reasonably foreseeable. Expanding medical assistance in dying to more patients could in fact diminish the number of medical professionals willing to take part in the process. The fact is that this expanded access could result in a heavy emotional burden on those health care providers.

None of us here can fully appreciate the burden put on those health care providers currently working in the system and providing medical assistance in dying. The fact is that there is nothing about ensuring proper support to health care professionals who provide this service and there continue to be no penalties for pressuring a medical professional into providing medical assistance in dying, nor are there penalties for punishing or penalizing a medical professional who does not participate in medical assistance in dying. This means there continues to be no real protection for conscience rights for health care professionals.

The issue of advance directives, now rebranded as a “waiver of final consent” by this government, is a complex one that poses questions of ethics and safety and issues with oversight. The fact that the legislation legalizing this is half a page of a bill shows a lack of care given to this issue. This issue rightly should have been discussed as part of the parliamentary review to take place this summer.

The process for the creation and execution of this agreement remains ambiguous. Further, there is a lack of clarity on the process for proceeding with an advance directive agreement upon the date selected. The process will only be stopped if a patient expresses a form of resistance, but we do not know what that looks like. What if they are simply confused or groggy at the time? Under the legislation, unless they resist, the process will still proceed.

The bill also removes the 10-day waiting requirement when a person's death is reasonably foreseeable. When I read in media reports before the bill was tabled that this would be included, I, like many of many of my colleagues and parliamentarians, questioned as to what prompted its removal. I still remain incredibly concerned as to why this was included. This is particularly true because there was already the ability to remove the 10-day waiting period if a person's death or loss of capacity to consent was imminent, so why proceed with the removal of a safeguard that Parliament saw fit to include in the previous legislation?

It is also confusing that Bill C-7 requires a 90-day waiting period when a patient's death is not reasonably foreseeable. Why add an extended wait period for one, but remove the wait period entirely for the other?

On the issue of whether a death is reasonably foreseeable or not reasonably foreseeable, there is no clarification or guidance for health care professionals. As a result, it is not up to them to make the determination as to what category to put a patient under. That determination will decide whether a patient can access medical assistance in dying immediately or if they will require a 90-day waiting period. This is an extraordinary amount of pressure that the government is putting on health care professionals across this country.

The changing of witness requirements under this legislation has also been mentioned. The law requires only one independent witness, which is down from two.

All of these changes lead to an expansion of the law in Canada far beyond what was addressed in the Quebec court decision, an expansion that should have required deeper reflection through the study that is to take place this summer.

For a moment, let us speak to a point that seems to be lost in this conversation: palliative care services in this country.

The reality is if the choice is between a lack of quality palliative care and medically assisted dying, that really is no choice at all. Unfortunately, over the past number of years there have been instances of patients feeling they were forced to choose death because of a lack of palliative care.

The story of Archie Rolland comes to mind. Archie was a Montreal landscape architect who chose to end his life rather than continue suffering at a long-term care facility that was failing to provide him adequate care.

He had ALS and had his life upended when he was forced to move from a Montreal hospital that specialized in treating patients with severe respiratory ailments to a long-term care facility for geriatric patients. Mr. Rolland did not want to go, but he was transferred against his wishes. He called the system “inhuman”. He felt he was not getting adequate care, so he chose death.

I do not think that this is any real choice at all. We must have the discussion in this country about palliative care because people must not feel forced into a decision on medically assisted death. Mr. Rolland's story makes it clear that there was a failure of the system to provide him with adequate care. We risk medically assisted death being seen as some sort of bureaucratic solution for people who require an extra level of care. In a country like Canada, that is simply not acceptable. The government risks expanding a culture of not valuing life, and we should all agree in this place that we must place value on human life.

In closing, the bill disrespects Parliament and the parliamentary process. With Bill C-14, parliamentarians did a significant amount of work in the House and committee in an attempt to build consensus. The work was challenged by the Quebec Superior Court, but rather than defending the will of elected representatives in court, the Liberals immediately backed down.

Now the Liberals are responding not just to that decision but are also undoing the work of the joint committee on Bill C-14 by adding new measures.

Many of these issues should be dealt with in the summer when we have our scheduled parliamentary review. This is a complex matter that requires proper scrutiny and debate.

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

Madam Speaker, I thank the member opposite for his contribution to today's debate and I welcome him back to the House.

I will begin by correcting about five errors in the member's speech and then I will ask him a question.

The first point is with respect to the Truchon decision. It was not appealed, first because we agree with the substance of the decision and secondly because we disagree with prolonging the suffering of Mr. Truchon or Ms. Gladu or people like them.

The second point is with respect to health care providers and the potential of a chilling effect being exacted upon them. It is a valid point, and that is why we have entrenched important safeguards in the legislation, such as the requirement for advanced consent to be done in writing.

The third point is on people being pressured as medical practitioners to engage in this practice, which is patently false. Bill C-14 has conscience rights entrenched in its preamble and in the body of the bill, and the Carter decision, in its penultimate paragraph, said that the charter protections under section 2 for freedom of religion does not compel any health care practitioner in this country to provide this service.

With regard to the member's attempt at an analogy between the 90-day assessment period and the 10-day reflection period, they are different qualitative matters. Reflection is not assessment.

The member raised a very valid point about palliative care. We agree and understand that palliative care must be robust and we fully support the idea, which is why this government put $6 billion into home care, including palliative care, two budgets ago. Does the member agree that this was a useful investment?

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, I thank the parliamentary secretary for his question. He covered a lot of ground.

If the government agreed with the decision, and that is the basis for not appealing it, then why was that not in the original legislation to begin with?

All too often we see on the other side of the House a willingness to let the courts do the work that is rightly the work of Parliament, and we are seeing that again here. One court decision is made in one province, and then the government will hide behind that decision rather than appeal it to the Supreme Court of Canada as it should.

Now the government has brought in legislation that goes far beyond what this court was dealing with, which is reasonable foreseeability of death. That again should have been dealt with in the review that is coming up this summer, when all parliamentarians can get input from their constituents and from experts on this issue.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, I would draw the member's attention to what is known as Audrey's amendment in the legislation. One of the challenges is the requirement for final consent at the time the assistance is rendered. This forces a lot of people who have already been assessed and approved for medical assistance in dying to make a very cruel choice when they are faced with the possible loss of competence, which would make them unable to give consent. Sometimes they are forced to go earlier or risk not being able to receive the assistance they need in order avoid continuing to live with intolerable suffering.

I wonder if my colleague can inform the House if Conservatives support this particular aspect of the bill, which would demonstrably help people who are facing end of life avoid this cruel choice.

[Rob Moore, Conservative, Fundy Royal, NB]

Madam Speaker, in Bill C-14 from the previous Parliament, the decision was made not to include advance directives, meaning that someone would have to give consent at the time of medically assisted death. That is why, in the previous legislation, someone would have to consent and then give a further consent at the time of medically assisted death.

The bill before us would change that. This is a major expansion of Canada's laws on assisted dying. It was done under the premise of a response to an unrelated court decision in Quebec.

There is a reason parliamentarians and the House put in place a statutory review of this regime: so that we can consider new measures and look at what is working and see what is not working. This is why the whole discussion on this aspect of consent should have been done in the course of the statutory review.

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

It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Brandon—Souris, carbon pricing; the hon. member for Nanaimo—Ladysmith, indigenous affairs; the hon. member for Battlefords—Lloydminster, agriculture and agri-food.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, when this House opens most days, we take a moment to pray, reflect and ensure our words and our jobs of representing Canadians are done to our utmost ability. We are honoured to be in the people's House. My personal prayer today is that my words reflect the severity of Bill C-7, a very serious subject.

I have been closely following the Liberals' terrifying progress as they work to embed the practice of efficient death in our medical system. In January they held MAID legislative consultations online for a total of only two weeks; two weeks to hear from the public on legislation that is truly a matter of life or death.

There is a mandatory five-year review set for this June for our MAID law, but instead of working within that timeline, the Liberals have let one ruling from one Quebec judge dictate the legislative direction for the entirety of Canada. At minimum, this issue should have been referred to the Supreme Court of Canada.

I am fearful of the current justice minister who voted against MAID in the previous Parliament, not because he was against it, but because he felt it did not go far enough. That is the driving force behind some of these drastic changes.

As the Liberals have just tabled the bill this week, I have only had a short period of time to begin digesting it. I need to stress to the House today that these are my preliminary thoughts. In my opinion, this is a needlessly rushed process on a sensitive, significant issue that does touch every Canadian.

For the first four months of my term, I have heard from many concerned constituents, advocacy groups, differently abled individuals and organizations, and those in the medical profession.

What I need to emphasize at the outset of my time here tonight is the innate value of every human being, regardless of ability. I want to speak directly to those who are in physical pain, those in mental anguish and those who feel they are a burden. Everyone is loved, everyone is valuable and everyone is made in the image of God. There is a place in our society for patients in unbearable suffering with no possibility of recovery to be provided with end-of-life options. We owe this to Canadians. Autonomy and personal wishes do need to be respected.

There is a paradox, in that suffering is both hard and good. Everyone who suffers deserves our love, our care and access to appropriate palliative care. I will touch on palliative care in a moment, but presently I will address this bill, raise some of the concerns I have with it from my initial reading and voice the concerns of those it affects directly from whom I have heard, including our medical professionals and the vulnerable or disabled of our society.

Numerous organizations like Canadian Physicians for Life and Canadian Society for Palliative Care Physicians have raised numerous significant issues with Bill C-7. The organizations cite specific concerns with clauses of the bill and also relay an overarching general concern about how the proposed legislation erodes the trust that vulnerable people should be able to have in the medical profession.

We seek out medical aid when we are at the lowest, most vulnerable points in our lives. Vulnerable Canadians must be able to find protection within the medical community. In an ironic, tragic twist, the preamble of the bill recognizes the importance of protecting vulnerable persons from being encouraged to end their lives, but does nothing to support what should be foundational in our health care system.

The bill itself drops many of the already too few safeguards around MAID and places vulnerable people at an increased risk.

Point one is that the reasonably foreseeable natural death criteria has been removed, which would drastically reinvent MAID. It would no longer be an alternative to a painful death, but an alternative to a painful life.

Point two is that independent oversight has been reduced. Where two witness signatures were previously required on a patient's written request for MAID, the requirement would now be one. The bar would be lowered even further as that individual, that supposedly independent witness, can be the person paid to take care of someone, that is, medical staff.

Point three is that disturbingly, Bill C-7 also does away with the previous 10-day waiting period for those whose natural death is reasonably foreseeable.

Under Bill C-7, one could be diagnosed and killed all in one day, with no opportunity for reflection or discussion with friends or family members. That is what this bill would do.

Point four is that the bill would also legalize physician-assisted suicide by advance request through a waiver of final consent and drop the requirement for consent to be given twice before MAID is performed. The existing law requires consent at the time eligibility is granted and again before termination of life occurs. Under the new law, once consent would be given, there would be no need for medical staff to confirm it before administering a lethal injection.

Can someone consent in advance to being killed once they reach a state they fear but which they are not experiencing now and, in fact, have never experienced? Once a person has signed an advance request and has lost capacity to consent to medical treatment, at what point should euthanasia take place? At what point should a person be killed?

In a technical briefing yesterday, officials were pushed to explain how MAID would be administered and what safeguards would be in place for the day, the hour, the minute euthanasia would be carried out. Shockingly, the legislation would only require one medical practitioner to be present. Therefore, even if an individual attempted to withdraw consent, there would be no mechanism to ensure their wishes were respected. One medical professional should not be permitted to conduct euthanasia alone. This would not ensure accountability and, in my opinion, is completely unacceptable.

Additionally, there is no provision for individuals to be able to seek doctors who would not counsel MAID as a treatment option. In fact, there is no mechanism for physicians to opt out of providing MAID or any conscience protections for medical professionals who refuse to participate in MAID or do not wish to refer a patient.

We are seeing this in British Columbia, where the Delta Hospice Society has been denied funding for refusing to offer MAID services. With this in mind, how then are individuals able to trust that the doctor will really care for their well-being? The frightening thing is that pro-MAID health care providers are not waiting for people to raise the possibility of euthanasia. In fact, we are hearing first-hand accounts of individuals who have been encouraged to pursue this option unprompted.

What about section 241 of the Criminal Code, which counts it an offence to counsel a person to commit suicide? Those staring at the precipice of potential death should not have the entire medical establishment looming behind them to pursue a certain option.

This brings me back to palliative care and the dismal record on caring for Canadians at end of life. There is nothing in the bill and little tangible government action taken to approve access to palliative care. The Conservative dissenting opinion from the committee's review of previous MAID legislation states, ”A genuinely autonomous choice for a person to end their life is not possible if they are not offered palliative care as they will see their choice as only intolerable suffering or PAD [physician-assisted death].”

The Canadian Hospice and Palliative Care Association estimates that fewer than 30% of Canadians who need it have access to palliative services. The Conservative Party recognized this need in its 2019 platform and a Conservative government would implement the framework on palliative care in Canada.

As I referenced the Canadian Hospice and Palliative Care Association, I need to make one its points crystal clear, which is that MAID is not part of hospice palliative care. It is not an extension of palliative care, nor is it one of the tools in the palliative care basket. Health care articles, the general media and, sadly, politicians continue to conflate and thus misrepresent these two fundamentally different practices.

Hospice palliative care focuses on improving quality of life and symptom management through holistic, person-centred care for those living with life-threatening conditions.

In conclusion, at my first reading, I am disappointed to say that the Liberal government's proposed legislation to amend MAID sadly misses the mark on many levels. It had the opportunity to increase safeguards for the vulnerable, provide conscience right for medical practitioners, implement protections for those living with mental illness and address many more legislative inadequacies. I hope that in the spirit of this minority government the suggested amendments coming from all sides of the House will be welcomed graciously and thoughtfully.

To my constituents, I am opposed to these changes and will urgently seek their feedback. Many of them live with stories and experiences on both sides of this issue and I need to hear from all of them.

To reiterate, to those who are in physical pain, who are in mental anguish and who feel they are a burden, they are loved, they are valuable and they are made in the image of God.

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

Madam Speaker, I am going to offer four clarifications and then ask the member a question.

The first clarification is that, with respect to the conscience rights and whether they exist, they do exist in three places and I outlined them already: in the preamble, in subsection 241.2(9) of what was then C-14 and in the Carter jurisprudence. I think that is important, because this member is urging us to return to Supreme Court jurisprudence.

The second is about withdrawal of consent. Can it be done? Yes it can, through non-verbal means. That is entrenched in this bill.

The third is that the notion that people can die “all in one day”, and I am quoting the member opposite, is actually patently inaccurate in terms of the empirical evidence. There are two independent medical practitioners, completely divorced from the people who verify the identity of an individual, who determine the eligibility. Those people take some time to do so. It does not happen “all in one day.”

Finally, the issue about the independent witness going from one to two is simply to reduce one of the barriers.

If the concern is for ensuring that the autonomy and dignity of all individuals are entrenched here, does the member opposite agree that when the court, in Carter and in the Truchon decision, talks about ensuring that intolerable suffering is no longer continued, and that the dignity of those people who are making a personal choice about how they choose to exit this life should that be respected in the context of this legislation?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, this legislation was tabled on Monday. We are Wednesday in the House of Commons, and the changes being made are so drastic that all sides of this House need to take time to properly understand the impact of what is before us today, and properly understand that this is going to change our society in major ways. We do not know the full effect of what is going to take place now.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I was listening to my Conservative colleague and wondering whether I had understood him correctly and whether the interpretation had faithfully rendered his argument.

I heard that the medical establishment would push for death in the case of someone who is terminally ill. If the medical establishment could do what my Conservative colleague is suggesting, that would constitute criminal wrongdoing and the perpetrators would be immediately discharged. There are codes of ethics for that. I am not sure if that is what the hon. member was saying or if the interpretation was inaccurate.

I agree with my colleague that palliative care is needed. However, is he claiming that palliative care is the answer in every case? Does he know that palliative care does not adequately relieve pain and suffering in some terminally ill patients?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, what I was referring to was what I heard in my riding, that medical practitioners were raising MAID without MAID being raised by the patient. That is what I was referring to.

[Philip Lawrence, Conservative, Northumberland—Peterborough South, ON]

Madam Speaker, the hon. member had mentioned that we should be informed in the House. I am wondering if the hon. member thought it would be wise, perhaps prior to the release of the legislation to the media, for the government to provide us with the results of their consultation, because I do not believe we have it.

Would that consultation be helpful for us?

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Madam Speaker, yes, I think it is irresponsible on the part of the government to have tabled this legislation without hearing back from Canadians. As I mentioned in my remarks, two weeks for Canadians to respond to such important legislation was not sufficient, especially when we compare the all-party process of 2016 with what is happening now. This is not acceptable for Canadians, and I know for a fact that more Canadians wanted to have a voice on this. Canadians from all sides of the issue wanted to be able to share their perspectives with the government in good faith, and they were not given that opportunity.