Debates of Feb. 26th, 2020

Criminal Code

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, it is with some emotion that I rise in the House today to speak to Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.

We are debating Bill C-7 today because the legislators who were here four years ago did not do their job properly when they debated Bill C-14. We do not live in a democracy run by judges. We are the ones that make the laws and who must make the voices of citizens heard, particularly the voices of those who are suffering. All judges do is interpret the grammar of justice. They look at the laws and people's rights and freedoms and determine whether the infringements are reasonable or not. However, before Bill C-14 was introduced, two courts told us that, according to the law, the Criminal Code infringes on the right to life and the right to liberty and security of those who are ill and suffering, are struggling with unbearable pain or have a terminal illness.

Today, I hope that we will seize the opportunity that is given to us. I hope that we will extend the debate until June because this is a serious subject. I hope that we will have a calm, rational debate.

I will start by saying that I am sure my colleagues in the House all have good intentions. They want to do good. They have kind hearts. I am sure that their behaviour throughout the debate will reflect the very values they are advocating, namely benevolence and caring. However, we cannot be benevolent and want what is best for a terminally ill person if we refuse to listen to what that person has to say before they die.

All I want is for us to understand what is at stake here, I am referring to the law, which my Conservative friends have always put on a pedestal. The value of autonomy is conferred by law through the principle of self-determination, especially with regard to medical care. I will come back to that.

I will take a moment in this debate on such a crucial and delicate issue to say that I hope all my colleagues get to cross the threshold of death peacefully, quietly and painlessly. That is my wish for everyone, because the best fate we can wish on another human being is to find peace, to let go and to receive what is known as good palliative care if they are terminally ill with an irreversible ailment. More on that later.

Today we are discussing the autonomy conferred by law through the principle of self-determination. In the biomedical context, there is a rule. A value gives rise to a principle, which in this case is self-determination. This principle gives rise to a specific rule, namely the rule of free, informed consent. The rule about free, informed consent to treatment has never been challenged in emergency situations.

Why would it be any different for human beings experiencing intolerable suffering due to an irreversible illness or condition?

Why would it be any different for competent individuals who are neither depressed nor suicidal and who have expressed a desire to live fully until they reach the limit of what they can tolerate?

I therefore invite my colleagues to join me in a debate on autonomy and self-determination. If someone shows up at an emergency room, they cannot be treated without their consent. Everyone has the right to refuse treatment, by the way.

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

The court stated that those provisions were effectively shortening the lives of such individuals, that they violated their right to life by inciting them to commit the act before they were ready. That is the issue that we are called upon to address. There is no issue for people who are terminally ill. The issue we need to address as legislators has to do with people whose death is not reasonably foreseeable and imminent.

The bill proposes that a person who is not terminally ill must consent twice and be bound by a 90-day period. I really wanted to talk about advance consent. I imagine we will do so eventually. That is about all that is missing from the bill. Clearly the Bloc Québécois is in favour of passing this bill in principle.

What we want is respect for the moral autonomy of the dying. We often speak of dying with dignity. Dying with dignity does not mean having a sanitized death. That is not it. The dignity of a person is derived from their freedom to choose and respect for their free will. That is what it means to be a human being. When that is violated, we violate the dignity of the human being. Whether the death is unpleasant or not is not the issue. The crux of the matter is to allow the human being to make a decision about the end of their life.

Unfortunately, in the past, we won the right to die rather than undergo aggressive therapies. At the time, we called this passive euthanasia. The person was left to die without death being the intent. Palliative care was still in its infancy. There was a great fear of administering one last fatal dose of medication, which always ends up causing death, because palliative care provides care.

Human beings won the right to die rather than undergo aggressive therapies. People did not die of cancer; the therapies killed them. Experiments were conducted on human beings. Doctors led the way to ensure that they would have quality of life if they were to be struck by cancer. They did not want to receive treatments that would make them ill for a year when they only had two years to live.

The right to die won out over aggressive treatment plans. That idea evolved and became palliative care.

For a long time, palliative care was thought of as the only solution that would allow someone to die with dignity. However, in the past 30 years, were there people living with terminal illnesses, dying a slow, agonizing death, who did not receive all of the palliative care they needed until the end of their life, if that was what they wanted?

First, we need to look at whether palliative care is accessible. There is an increase in requests for medical assistance in dying. Bioethics talks about clinical ethics, in which the patient comes first. It is about listening. Sometimes, even the best palliative care in the world, with the best framework in the world, cannot alleviate someone's suffering.

That is true for Ms. Gladu and for Mr. Truchon, but those people are not suicidal. They want to live as long as possible. When they want to die, they may be given anti-depressants. They will be of sound mind when they make their decision. That decision will be reversible. I was listening to Ms. Gladu the other day. What does she want? She wants freedom of choice. In many cases, once people have that choice, they have so much respect for their dignity that they are no longer in such a hurry. That reduces suffering tremendously. That is the issue we are dealing with.

We must not sidestep this issue on the grounds that we want to move swiftly. I have a lot of questions about the bill because it does not address degenerative cognitive disease. I think a person with Alzheimer's should have the opportunity to make an advance request.

These are predictable diseases. Doctors can tell patients how they will progress. People with these diseases often remain of sound mind for years. Eventually, they become forgetful. In the end, they die not of the disease itself but of complications from being bedridden or immobilized or conditions other than that disease. This bill does not take those people into account.

What I would hate is to see a repeat of what happened with Bill C-14. The reasonably foreseeable natural death criterion was established, and it was supposed to protect vulnerable people.

Is there anyone more vulnerable than someone who is suffering from intolerable pain, who is living with an incurable illness and who is being told to go to court for the right to choose and to die with dignity?

Is there anything more important and more intimately personal for an individual? It is not as though the person's neighbour is going to die for them.

I have a hard time understanding our Conservative colleagues' argument that the state must decide for an individual, when they are so economically libertarian.

In 1957, Pope Pius XII was a pioneer. He said that we must stop claiming that only God can decide whether we should die a slow death. At a certain point, he made it possible for us to sanction palliative care.

Today, let us not pit palliative care and medical assistance in dying against each other, regardless of whether we are talking about a degenerative disease or an illness that causes extreme pain but is not terminal. Let us not pit those two realities against each other. Respect for human dignity includes proper support when one is dying, which requires doctors to have the humility to recognize that they cannot always help people manage their pain adequately.

Our society recognizes people's right to self-determination throughout their lifetime but takes it away from them at the most intimate moment of their lives. In so doing, we think that we know what is best for people or that we are doing the right thing, when we are actually undermining human dignity. There is no more important moment in a person's life than their death. Learning to live is learning to die. Learning to die is learning to live. I say that because the clock starts ticking the moment the doctor cuts the umbilical cord.

I appeal to my colleagues' humanity. I am a staunch democrat, humanist and, of course, sovereignist. I am all of those things, but one does not take precedence over the other when it comes to problems like this.

I am not saying that the federal government should have challenged that ruling because it came from a Quebec court. In any case, it is a court under federal jurisdiction that rendered that decision.

This ruling challenges us as legislators to do our job and stop off-loading the problems, the ethical, social and political questions to the courts. We have a job to do as legislators.

There is a sociology of law. In a society, the law evolves with people's consciences. I know I am straying from the technical details of the bill. However, I said from the outset that we agree in principle and on the grounds for discussion of this bill. I apologize for being overly philosophical today, but that is where the substance of the debate lies; it is ethical and it is political in the noblest sense of these words. Indeed, it is up to us to make the laws to ensure the well-being of all. It is a philosophical debate and, in a way, a theological debate that leads us to the law. However, regardless of how much time we spend on this, let us use substantive arguments.

When I hear arguments to the effect that this is a slippery slope, I think about the study of Bill C-14, during the last Parliament, when some people were practically saying that nursing homes and long-term care facilities would become euthanasia machines. I do not know of any evil people who work in health care, in any position. If such a person exists, then let them be fired, because they have no place there. I am not buying the slippery slope argument.

We must assume from the outset that all stakeholders in the health system are caring and compassionate. Yes, they sometimes experience difficulties. With just a slight increase in health transfers, they could provide better care and there might be more palliative care units in hospitals. Even though I do not believe that palliative care is the only solution, that is what people have been saying for 50 years. It makes no sense that there are not more palliative care units.

Not everyone asks for MAID. I talk a lot about those who do not pose a problem. In Quebec, where the Quebec law is in effect, the obligation to meet the criterion of a reasonably foreseeable natural death forces people to go to court or to go on hunger strikes. This criterion was unconscionable, and the courts handed down an appropriate ruling in that regard.

Therefore, I appeal to my colleagues' humanity.

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

Madam Speaker, I truly appreciated my hon. Bloc Québécois colleague's speech. He spoke very eloquently about the balance we hope to strike between protecting the vulnerable and respecting the dignity and autonomy of people who want more control over their manner of dying. The member mentioned that.

I also want to point out that medically assisted deaths accounted for only 1.89% of all deaths in Canada in 2018. I would like to ask the member a question that was raised by the member for Mission—Matsqui—Fraser Canyon. He said that we did not listen carefully enough to what Canadians want. In fact, we launched a questionnaire that garnered 300,000 responses, most of which supported expanded access to medical assistance in dying.

What does the member opposite think Quebeckers and Canadians want with regard to the possibility of expanding access and eliminating obstacles to medical assistance in dying?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I think the government was sort of playing with fire with respect to the time frame. We do indeed want an extension. I think the debate that is starting today will help the courts give us that extension. After all, the courts do not make the law, and I think it is worth spending at least four months on this.

I think we can get this done because we have experience. We dealt with the issue of medical assistance in dying as part of end-of-life care. Quebec did that without having to amend the Criminal Code. Then the Carter decision came out. I am eager for the committee to be set up. I think we can produce a first draft that I hope will be followed by a review of the legislation focusing on sensitive issues, which could be done immediately after a bill is passed.

I am quite pleased that the government was wise enough not to extend medical assistance in dying to individuals with a mental illness. However, the problem has not been resolved. When someone continues to suffer, despite years of treatment, to the point where they are considering death as the only possible relief, that is a failure for the medical profession in terms of mental health. There is no palliative care in mental health. This issue needs to be raised and addressed. Although I am pleased that it was not included, I do think it warrants careful analysis. That is why I proposed that the Standing Committee on Health examine the issue. We will see whether my colleagues agree.

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

Madam Speaker, the speech of my colleague from the Bloc was very passionate speech. I very much enjoyed listening to it.

When we looked at this issue in the previous Parliament, what was very clear back then was the Carter decision. What was very clear back then were the recommendations of the special joint committee. What was not very clear was why the government at the time had inserted the clause that required a reasonably foreseeable death. During my speech on Bill C-14 in 2016, I knew that clause would force us to come back and revisit this issue.

Parliament did look at this issue, we did deliberate and a number of parliamentarians at the time identified this as a problem. Then I see the Truchon decision, and that simply forces Parliament to clean up its act, to actually get the job done properly this time.

Who are we to impose our values on people who have gone through the suffering, who are being forced to live with these medical conditions? We have no idea what kind of a world they are living in. The member is very right that it is about treating their life with dignity and also allowing them to die with dignity in what is an incredibly personal choice.

I want to get my colleague's thoughts on a particular section of the bill that sets the assessment period at 90 days. For someone whose death is not reasonably foreseeable, but is facing intolerable suffering, what does he think of the 90-day period? The New Democratic caucus has already heard from physicians who have great concern that they may have to force their patients to wait an additional 90 days when it is already quite obvious the suffering is very grave.

Could my colleague provide us with his thoughts on that section of the bill?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, we will need to look at this scenario in detail. Earlier I said that the patient comes first.

My Conservative colleague claims that it would be possible for everything to happen in one day. That is not how it works. I did support eliminating the 10-day waiting period, however. We need to get this right. Depending on the illness in question, there will have to be a process. It is a matter of prevention.

What is the current process? Take Ms. Gladu, who, if I am not mistaken, said in her interviews that she is going forward. For her, another 90 days will be complicated. She is suffering. However, for someone who has just been diagnosed, the 90-day period is completely acceptable. There will have to be some flexibility.

Renowned bioethicist David Roy said that the patient comes first and that clinical studies are opportunities to hear what patients are saying. These studies allow us to make humane adjustments, in line with rules and legislation, to an individual's end-of-life care.

I am open to looking into all of that. Even though it appears simple, a discussion about days, about a 30-day waiting period, is very complex.

I hope we will be able to count on my colleague's support to improve the bill.

[Lloyd Longfield, Liberal, Guelph, ON]

Madam Speaker, the member's presentation was very thoughtful and intelligent. He has presented us with a very personal choice that each of us will have at some point in our life and death experience, some of us through suffering and some of us through other ways. I am sure we will be passing in different ways.

However, there is the protection of people who might have to make a decision based on their experience, based on where they are in their life, then coming to the end through suffering. I was with my mother when she was going through some of the struggles of the end of life experience and she really had trouble with the final moment.

Could the hon. member talk about our role in the decision-making process as members of Parliament, in which we try to represent different experiences of faith, different experiences of people, different experiences of suffering, and the role we have in providing freedom of choice for the people we are representing?

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, at this point, I do not see anything in the bill that disregards or disrespects any faith.

Some people decide to die with the help of palliative care and nothing else. That kind of care can slow down the dying process. Sometimes people are admitted in an emergency and get sent home because the care is so good their condition improves.

People will have a choice. This is about freedom of choice. Both options will be available. People will exercise their free will and their freedom of choice. That is truly what it means to respect a person's dignity.

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

Madam Speaker, it is quite incredible to be revisiting this issue. I can remember when the debate on Bill C-14 went on, back in 2016. There were some amazing speeches uttered in Centre Block during that time. This truly was an issue that had a profound effect on so many members in the chamber but, we know, also on so many members of our society.

I was honoured in 2017 to serve as our party's justice critic. I am pleased to again be serving in the role as the deputy justice critic for the NDP. I have always felt that this particular critic role brings with it a very great weight of responsibility, especially when we are dealing with the Criminal Code. I do not think there is any other statute in Canada that has such a profound effect on people when they violate any of its provisions. It also gives a lot of guidance, as is the case in medical assistance in dying, over the parameters that are set up.

Regarding medical assistance in dying I, like many members in the chamber, received a lot of correspondence on the issue back in 2016, both from constituents who were against it and from constituents who wanted me to take up the cause.

I think that is the challenge that we as members of Parliament face on a regular basis. We have to look at our constituents' wishes, but they are not always very clear cut. We have to try to balance those with our own personal views on the subject and, at the end of the day, try to be accountable for the decisions we have made on behalf of our constituents in this place.

When it comes to an issue as complex as medical assistance in dying, I fundamentally believe that we must go beyond partisanship and work together with a compassionate lens. Ultimately, we must make sure that Canadians can die with dignity, compassion and fairness, and without excessive suffering.

I am pleased to see the introduction of Bill C-7 as part of the effort to help those who are looking to end their unnecessary suffering as they face the end of life. Bill C-7 is coming to us as a result of a decision in a Quebec court. For me personally, and for many members of the New Democratic caucus, it was quite evident in 2016 when we were debating Bill C-14 that this issue would come back to us. We knew it was only a matter of time.

I can remember referring, in the debates on Bill C-14, quite clearly to the Carter decision, which was handed down by the Supreme Court on February 6, 2015, in the final months of the 41st Parliament, when the Harper government was in power.

When the present Liberal government came to power in 2015, this was one of the major challenges it was faced with, because there was an impending deadline and there was a real rush to get in legislation that was going to respect the Carter decision.

I want to give a shout-out to two of my colleagues, Murray Rankin and Brigitte Sansoucy. As members of the New Democratic caucus, they sat on the special joint committee that looked at this issue as a result of the Carter decision, and presented the committee's recommendations to the House of Commons.

When we look at the Carter decision, which really started this whole process rolling just over five years ago now, we can see that they felt the prohibition on allowing people to take their own lives because of suffering violated their Charter rights. I will just quote from the ruling. It was stated that:

Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.

It went on to say:

An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.

Thus, it violates section 7 of the Charter of Rights and Freedoms. Just to read it into the record, so that everyone is quite clear on what we are referring to, section 7 reads that:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

What Carter was clearly explaining to people was that by not allowing people this option, by keeping them in a state of constant suffering, of basically confining them to their bodies, we were in fact violating their section 7 rights. That was the clear message that was delivered to Parliament.

There is always a careful dance between our courts and the legislature. The courts, of course, are very much responsible for interpreting the law, but also finding when such a law runs contrary to our Constitution. They also recognize that Parliament has its role to play as the lawmakers, as the one institution that can amend the law based on people's wishes. That was the task that was handed to us at the beginning of the 42nd Parliament.

When that special joint committee with the other place was formed, there were some clear recommendations that directly followed from the Carter decision. Recommendation number two, which I will read into the record, was as follows:

That medical assistance in dying be available to individuals with terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The problem that led us to where we are today was the fact that Bill C-14, as a government bill, decided to insert a reference to “reasonably foreseeable death”. This meant that if one had a medical condition for which death was not reasonably foreseeable, one could not qualify for medical assistance in dying.

Also, as a part of that special joint committee's recommendations, it did touch on the subject of advanced directives which is also, I am glad to see, addressed in Bill C-7.

The Truchon decision of 2019, in the Superior Court of Quebec, involved two plaintiffs who were each suffering from grave and incurable medical conditions that caused tremendous suffering and a total loss of autonomy.

They were 74-year-old Nicole Gladu, who used a wheelchair and had post-polio syndrome, which is a condition that weakened her muscles and reactivated her childhood scoliosis. She had difficulty breathing and was in constant pain. As well, there was 51-year-old Jean Truchon, who was born with cerebral palsy and no longer had the use of his four limbs. He lost the use of his only working limb back in 2012, due to severe spinal stenosis that left him almost completely paralyzed and caused painful spasms. He gave up most of his activities and went into assisted living since there was little he could do by himself.

Both of these individuals were refused medical assistance in dying under the Quebec legislation regarding end-of-life care as they were not at the end of their lives. Their deaths were not reasonably foreseeable.

With those grave medical conditions, they were prisoners in their own bodies but unable to find any relief. Really the heart of the matter here is how we, as an institution, respect individual autonomy. We can only imagine the pain and suffering they were going through on an hourly basis. When two individuals have arrived at this decision and obviously had the time to think about it, I think it is incumbent upon us to respect that, but more importantly to respect the fact that we have had a court look into this and determine that their charter rights were fundamentally violated.

That brings me through the long journey over the last five years to Bill C-7.

I am pleased to see the bill introduced. The Minister of Justice was one of four Liberals who voted against Bill C-14. I think he is now have a moment where it has come full circle. Now, as the Minister of Justice, I hope he feels some satisfaction in bringing in corrective measures to address the problems he saw as a Liberal member of Parliament back in 2016, when he voted against the government's legislation at the time.

As is required by the decision of the Quebec court, Bill C-7 will expand access to medical assistance in dying to those whose death is not reasonably foreseeable. I can assure the House that we are providing our support to the bill in principle at second reading. However, we will be doing our due diligence when it reaches the Standing Committee on Justice to ensure that access to medical assistance in dying has not been unreasonably restricted for those whose death is not reasonably foreseeable by the addition of the new conditions in the legislation.

We also want to ensure the standard of eligibility for receiving medical assistance in dying remains high. We remain disappointed that there has been no commitment by the minister to refer the question of the adequacy of the safeguards against pressure to seek medical assistance in dying to the formal legislative review, which will begin in June, again at the Standing Committee on Justice. Perhaps the government can hear those words, reflect upon them and address our concerns with respect to that aspect.

Going into some of the finer details of the bill, essentially there is a two-track process in Bill C-7. There is one for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable.

For the one where death is reasonably foreseeable, the 10-day waiting period is removed; the number of independent witnesses required for the written request is reduced from two to one; a paid professional or health care worker can be an independent witness; and the creation of a waiver of final consent.

For the second track, which is ultimately the part of the bill that is responding to the decision from the Quebec court, a few more restrictions are in place. The first big one, which will warrant some further study at committee, requires a minimum 90-day assessment period, which I think the legislation states can be shortened if loss of capacity is imminent and the assessments have been completed.

However, as I have said in previous questions and comments, we have already heard from some members of the medical community. They say that the 90-day assessment requirement may mean their patients have to endure another 90 days of suffering. For physicians, who take the Hippocratic oath to do no harm, if their patients are experiencing harm every day because of that suffering, that weighs very heavily on their conscience.

There are some other specifics in that other track process that I do not think warrant going into too much detail at this stage. The Standing Committee on Justice do that.

I also want to touch on another aspect of Bill C-7, which is the advance directive. This is known as the Audrey Parker amendment. It refers to Audrey Parker, a Halifax woman who was diagnosed with stage four breast cancer, which metastasized to her bones and a tumour on her brain. She spent the last weeks of her life raising awareness about the challenges facing Canadians who had been assessed and approved for assisted dying. She opted to die earlier than she would have otherwise wanted to. The legal requirement in the existing legislation is that the suffering person has to be competent immediately before the life-ending treatment is administered.

That presents a number of problems. If someone has already been approved for medical assistance in dying within the tight confines of what is written in Bill C-7, he or she can give that advance directive so that those wishes will be fulfilled even if there is a loss of competency. It would remove a sense of pressure that could be brought to bear on individuals who may feel compelled to take their life earlier, while they still have competency and the ability to act on their own directive. Therefore, I think this is a particularly important section of this legislation that should be noted, and I certainly look forward to seeing what kind of testimony we hear at the justice committee.

I have received some correspondence with respect to the Audrey Parker amendment. I have an email here from a constituent. She sent me a copy of her letter to the justice minister. She states:

These steps ensure that the patient qualifies for medical assistance in dying under the law, making the late-stage consent requirement unnecessary — and puts an enormous physical and emotional strain on people who are at risk of suddenly losing capacity, or who need heavy medications to manage their pain.

Most importantly, this unfair requirement means that people in the Assessed and Approved category are faced with a cruel choice: access assisted dying now, or wait longer and risk losing out on their right to a peaceful death.

Right now, dying people are ending their lives far earlier than they would like, or are refusing adequate pain care out of fear that they will lose out on their right to a peaceful death. This is an unacceptable burden for anyone to bear, and it is a clear and grave violation of Canadians' Charter rights.

That is just an example of some of the correspondence I have received on that particular aspect. It is actually really nice and refreshing to hear someone lay it out quite clearly because I think if we were to visit any riding we would all have constituents who have faced those pressures.

This is weighty subject matter. I know that in this chamber and indeed across this great country there are going to be multiple views on whether we are in fact going down the right path.

In moments like this when we are called upon to make these momentous decisions, we are required to look inside ourselves and to switch more from sympathy to empathy. I see this difference between the two. Sympathy is feeling sorry for someone else, while empathy is trying to put oneself in that person's shoes in order to view the world as she or he sees it.

The truth is that the members of this chamber who are lucky enough to have their health and to lead privileged lives cannot adequately express or feel what it is like to live in a body that feels like a prison and to know that kind of suffering. My ultimate view of this bill, and what guides me in the direction we need to take, is that it is about trying to make sure we can give people the dignity in death that they had in life, to respect their autonomy, to respect their choice and to make sure that their charter rights are not violated.

I conclude by stating that the New Democrats will be supporting this bill at second reading, with the full realization that the committee work is before us, which will be a real opportunity to hear from members of the public and witnesses. Hopefully, when this bill returns to the House we will have a product that we all feel we have done our best on and that lives up to the important wishes of our constituents who are living with these incredible amounts of suffering.

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

Mr. Speaker, I want to thank the member for Cowichan—Malahat—Langford for his contributions in the previous Parliament and for his contributions now and forthcoming at justice committee. I would also like to thank him for his and his party's general support of the bill.

The member cited at great length both the Carter decision and section 7 itself, reading it into the record, and that is important.

I want to put to him something that was raised earlier in the context of this debate by the member for Fundy Royal, where it was effectively put to us that not only are we seeking to comply with Truchon but we are actually going beyond Truchon. That was a reference to which the member had just left off in his comments when he talked about the advance consent regime in the Audrey Parker amendment.

In terms of everything that I have heard in my riding and the round tables that we have had around the country, this is where Canadians are, that in the context of a person who is assessed and approved is merely waiting for the date of his or her passing to allow them to have a regime where they could provide consent in advance is important step forward. I wonder if the member could comment on that. It is not squarely within the Truchon decision, but I firmly believe that is where Canadians are asking us to go and that is why it is in the legislation. Does the member agree?

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

Yes, Mr. Speaker. We canvass the Canadian public, particularly with respect to the Audrey Parker section of this legislation and we explain to Canadians the really horrible choice that a lot of people might find themselves in. These are people who had qualified for medical assistance in dying but may not, under the current legislation, be eligible to receive it because they lose competency. Just imagine the amount of fear and pressure that must bring to them to either heavily medicate themselves to try and maintain that competency or maybe pressure to use medical assistance in dying much earlier than they are actually prepared to do.

With this particular section, allowing someone who is in such a state to give that advance directive is quite reasonable. More importantly, it respects the autonomy of that individual and the incredibly important and weighty decision that they have to make to do such a thing.

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

Mr. Speaker, I want to pick up on the question of advance consent. It is important to note that there is nothing in the legislation which requires the person to be consulted or informed of what is going on at the point at which he or she receives euthanasia if they had entered into the agreement in advance. This raises a concern.

If I sign an agreement asking for euthanasia on May 1, and at that point maybe I have lost capacity but I still have a certain general awareness of what is going on around me, should I not at least be asked at that point, told what is going on, and have my general comfort level with what is happening to me at that time assessed? It seems to me reasonable that we would ensure as much as possible there is some element of contemporaneous consent as well. Would the member agree with that?

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

Mr. Speaker, the safeguards that need to be in place for medical assistance in dying are incredibly important. We want to make sure that at all stages patients, should they change their mind, have a way of opting out.

If the member has particular concerns with how Bill C-7 is currently written and is concerned that there is not enough addressing the concerns he just brought up, perhaps there will be an opportunity for some slight amendments at committee. I am sure that myself and the member for Esquimalt—Saanich—Sooke, who serves as our main justice critic, would be willing to look at his proposed amendments to see what he proposes to make that particular section of the bill stronger.

[Alexis Brunelle-Duceppe, Bloc, Lac-Saint-Jean, QC]

Mr. Speaker, I want to thank my hon. colleague for his speech. I really appreciated the words he used, especially when he was talking about empathy.

Prior to that, my colleague from Montcalm also delivered a wonderful speech. He talked about our role as parliamentarians. I see how the two speeches intersect. As parliamentarians, should the work we do not be driven by empathy?

I want to compare what we are doing to what happened in Quebec's National Assembly when this bill was passed. The bill was introduced by the Liberals, but the bill's sponsor was a Parti Québécois member, Véronique Hivon. She took a non-partisan approach to drafting the bill.

Does my colleague believe we should take our cue from what happened in Quebec's National Assembly and adopt the same approach here in the House of Commons as we work on this bill?

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

Mr. Speaker, I agree with the member. As I said in my opening remarks, this is a subject with such weight and importance to so many people across this country, whether they live in Nova Scotia, Quebec or in my home province of British Columbia. We owe it not only to ourselves in this chamber but to the people we represent to treat this subject with the respect it deserves.

As a member of Parliament who served in the previous Parliament, I was, by and large, quite impressed with the tone of debate on Bill C-14. I know there were some disagreements on the bill, but members ultimately tried to bring their disagreements and respective positions on the bill to the floor with as much respect as possible. During many of the speeches in this place at the time, members who were here will remember that the chamber was so silent we could hear a pin drop, because we knew how important the bill was to members speaking and, more importantly, to their constituents watching back home.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Speaker, I would like to thank the member for Cowichan—Malahat—Langford for his dignified and important speech on a subject that we admit is difficult for many people and is extremely important.

I know the member is extremely close to his riding on both sides of Malahat, from Langford up to Cowichan, and that he is home every weekend speaking to his constituents. I am very interested to know what his constituents have told him through this process. He brings a lot of experience and wisdom to this particular issue and the bill. What have people back home been telling him about the approach that Parliament should take?

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

Mr. Speaker, I have already received some correspondence on this particular bill. A number of people back home have already organized a community meeting with me on this legislation when I am back in the riding during the constituency week next week. It is a group that had a lot of concerns with Bill C-14. Based on their faith, they had some real concerns with it.

I knew when I walked into the room to meet with them the first time that we were not going to walk out in agreement with each other. However, I think we surprised each other with how respectful we were. We walked out of there respecting each other's positions, with a sure knowledge that we had each given this issue some deep thought. I expect that the same tone of conversation will happen again when I meet with them next week to discuss this bill.

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

Mr. Speaker, I had the privilege of serving on the justice committee with the member for Cowichan—Malahat—Langford in the last Parliament. I had the benefit of serving as the vice-chair of the Special Joint Committee on Physician-Assisted Dying and then served on the justice committee following that, when it dealt with Bill C-14.

I acknowledge that the circumstances Audrey Parker and others like her found themselves in presents a real, difficult challenge from the legal, moral and ethical standpoint. However, a regime that provides for advance directives does cause me some level of concern.

In the Carter decision, the Supreme Court of Canada made clear that there must be clear consent. How can there be clear consent absent contemporaneous consent on something that is ultimately irreversible when carried out?

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

Mr. Speaker, that is a fantastic question from my colleague and I do not know if I can provide an easy answer. This is the struggle we have before us.

The Carter decision clearly outlines that consent has to be as straightforward as the member discussed. However, at the same time, I am presented with examples of people like Audrey Parker and others who felt pressured to take their lives early because that was when they could give consent. That is the struggle we find ourselves in: How do we balance a court decision with what we know are real and very current examples of suffering? I will admit that I do not have an easy answer to that, but this is the task we have been charged with.

I can only say that we have to go forward. We have to send the bill to committee. We have to hear from members of the Canadian public and experts involved in this particular aspect of the Criminal Code. We have to use our best judgment to arrive at a decision that we believe reflects not only our values but also the values of the people who sent us here to deliberate on their behalf.

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

Mr. Speaker, I will be splitting my time with my colleague, the member for Kings—Hants.

I am pleased to rise today to speak to Bill C-7. I have some prepared remarks, and during the course of my comments, I will try to sprinkle in some responses to some of the various issues that have already been raised.

Clearly, we are here because there was a decision of the Quebec Superior Court in the Truchon case. This decision struck down a particular criterion under both the Quebec regime and the Canadian regime with respect to the end-of-life nature of medical assistance in dying, this being the reasonable foreseeability of natural death criterion, in particular at the national level.

The court's ruling only applies in Quebec. We heard the minister speaking about this. He suspended its declaration of invalidity for a period of six months, until March 11. It is important for this chamber to understand 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. That motion was actually debated yesterday, and a decision from the court is forthcoming.

Before I go into some of the details in this bill, I want to start off with two important provisions related to conscience protection that were raised by members of the official opposition in the context of this debate. I want the record to be crystal clear that conscience protections are robust in this country and are entrenched in the law.

The first location is in the preamble to the old Bill C-14, which I will read. It 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 wrong, because it is in the statute. Section 9 on page 8 of the old Bill C-14, which amended subsection 241.2(9) of the Criminal Code, says “For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.”

The third point I will read 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 three instances. One is jurisprudential and the other two are statutory. The fourth one is of course the broad penumbra that is cast by 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 in terms of what is being addressed in today's debate is the notion that a culture of overly facilitating medical assistance in dying is upon us, and 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 security of persons who are vulnerable, including persons with disabilities. That is categorically false and is not commensurate with what is in evidence.

The evidence we have is readily available in the technical briefing that was already provided to all members of Parliament. It is that in total, 13,000 MAID-assisted deaths have happened in this country in the last four years. The average age of people who are accessing MAID is 75 years old. It is being accessed equally by men and women, 51% by men and 49% 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 importantly, 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 this country. I read that into the record because I think it is important for people 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 on my reasons going forward.

I would like to talk about some aspects of the bill. The eligibility criteria have changed, as the Minister of Justice pointed out.

There are two series of safeguards. The first applies to cases in which the person's death is reasonably foreseeable, while the other applies when death is not reasonably foreseeable. The bill would add new safeguards to that second category.

Lastly, the bill allows a person to waive final consent on the day of the procedure in certain circumstances.

I will return to that in a few moments.

Much has been made about the consultation process, including some comments by the member for Mission—Matsqui—Fraser Canyon about it being a rushed procedure and that the government is not adequately listening to Canadians. I have great respect for all members in the House who are participating in this debate and raising a number of very personal, ethical, legal and moral issues. I understand that; the government understands that.

However, to assert that the consultation was not robust is again categorically false. We heard from 125 different individuals, who are experts in this field, whether they are delivering it or acting on behalf of disabled individuals, and from nurses, doctors, etc. We heard from 300,000 Canadians through their responses to a questionnaire that outlined the 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 less 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 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 this debate. This is important, as was outlined by the minister. 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 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 to render someone eligible for MAID.

This complex issue must be examined carefully as part of the parliamentary review of the legislation on medical assistance in dying, which is to start in June of this year, as the minister himself mentioned.

Importantly, the Government of Quebec has also announced the exact same study for the exact same provision, that the issue of mental illness as a sole underlying condition is complex. Issues of consent and capacity and issues of properly being able to diagnose and have a prognosis are critical.

I will move to some of the comments that have been made. It is important for people understand that 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, we have have taken the 10-day period of reflection out of the legislation. This was put squarely into issue by the member for Fundy Royal when he asked about the basis for doing that. The basis for it was that the safeguard was not doing the work it was meant to do. As opposed to protecting vulnerability, it was actually increasing the vulnerability of individuals insofar as it was prolonging suffering in some instances.

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

On the question raised by the member for Sherwood Park—Fort Saskatchewan most recently with respect to how one assures informed consent is applied when it has not been solicited actively, I have 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 that they want to access it and provide consent in writing, that consent would be sufficient.

In direct response to the member for Sherwood Park—Fort Saskatchewan, could it be vitiated? Yes. First, if the person has not lost capacity, consent could be vitiated. Second, it could be done by a physical gesture that would be interpreted to fully and finally eliminate that consent for the purposes of the practitioners.

The bill strikes a balance and the balance is important. We are conscious that a compassionate response that protects vulnerable individuals and also respects their dignity and autonomy is critical and what is required by the Constitution.

That is what this bill represents and I am very hopeful, as the member from the Bloc Québécois pointed out, that we can achieve all-party consensus on that very fundamental point.

[Rob Moore, Conservative, Fundy Royal, NB]

Mr. Speaker, specifically on the 10-day cooling off period, does the parliamentary secretary acknowledge that under the current legislation, if necessary, those 10 days could be waived? That was a safeguard put in place by this Parliament and has been taken out in haste.

I would like the parliamentary secretary to comment on a couple of facts that deal with this Parliament. First, a two-week online consultation is not a parliamentary review. Bill C-14 called for a parliamentary review that was to take place this summer before we expand our regime in Canada around medically assisted dying. The Liberal government has jumped ahead with a vast expansion of the legislation without the benefit of that review.

Does the parliamentary secretary see a two-week online consultation having some equivalency with a parliamentary review?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, I will take those points in order. In terms of the 10-day reflection period, what we heard overwhelmingly, whether at the round tables or from some of the 300,000 Canadians who contacted us, is that period is not required because it prolongs suffering.

We heard the minister say in his opening remarks that a sufficient amount of reflection has gone into the point when a patient actually puts in writing a request for MAID. The reflection has already occurred.

What we do not want is a situation where people are coming off of their medication to ensure they are maintaining a full capacity and prolonging suffering that we need to alleviate through this bill.

A questionnaire online is not the same thing as a parliamentary review, but the two are not addressing the same thing. What we are addressing here is a narrow amendment that deals with the Audrey Parker situation for somebody who is already assessed and approved. What the parliamentary review will do, as it rightfully needs to, is study three major areas: requests for mature minors, requests for when mental illness is a sole underlying condition and an advance directive, which is very qualitatively different from advanced consent.

[Louise Charbonneau, Bloc, Trois-Rivières, QC]

Mr. Speaker, I would like to thank my hon. colleague for taking a step in the right direction when it comes to medical assistance in dying. Offering Canadians a clear personal choice for a dignified death without suffering is certainly one of the most humane acts. Nevertheless, while the easing of certain requirements might facilitate access to this service, certain points need clarification.

My question is this: Beyond these cases described as having a reasonably foreseeable death, what about the issue of advance requests, for instance, for people with Alzheimer's?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, I thank my colleague for her question and her comment.

Cases involving Alzheimer's and dementia raise questions regarding consent and capacity, some rather complex questions since they relate to the prognosis itself. These two types of cases will have to be examined in June as part of the review that Parliament is required to do under Bill C-14.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, the parliamentary secretary mentioned that advanced consent was different from advance directive. Could he elaborate on that?

[Arif Virani, Liberal, Parkdale—High Park, ON]

Mr. Speaker, advanced consent is a very important concept. Under the current regime, people who are approved for MAID have to give consent on the day they are meant to be provided MAID. What we now are proposing is that when that date arrives, if people do not have the capacity to provide an oral consent, they could do it in writing in advance. That is advanced consent.

What is not being proposed in the bill is an advance directive. If 30 years from now, I have a malady which I find intolerable in terms of my own suffering and I want to apply for and be given MAID, that would not be permitted under this law.

What is being proposed is that people who have already applied for MAID, have been granted eligibility and for whom the date has not yet arrived on which it is scheduled, on that date if they have lost capacity, they can provide it in writing.