Debates of Feb. 27th, 2020

Criminal Code

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I will be sharing my time with my very esteemed colleague from Shefford.

The debate we are having today must be handled with restraint, dignity and composure. Partisanship has no place here. This is a serious matter, and our decision will have significant repercussions on the lives of many, and perhaps even on our own lives one day, because we all have to leave this world sometime. It is inevitable.

The sad thing in all this is that, through decisions made in this very Parliament, our society has forced people who are suffering to suffer even more. People with severe medical conditions were forced to appeal to the justice system to have their most basic rights upheld. Worse yet, some had to go on a hunger strike to get access to medical assistance in dying by meeting the reasonably foreseeable death requirement. Do hon. members have any idea what we have asked these suffering patients to endure?

These long-suffering people coping with illness, trying to get through the day in unspeakable physical and psychological agony, were forced to go to court or put themselves in a position where their death was reasonably foreseeable. Everyone knows that the justice system is backed up. The costs and delays are typically unreasonable. These people had to endure a veritable ordeal because we made a decision for them.

We failed to make informed decisions that upheld individual liberty. It is a huge privilege to sit in this House, and with that privilege come serious responsibilities. We must honour our position. I want all members of the House to know that this time, we cannot fail. Courageous patients have had to fight the system to get us to make a wise, informed decision. The Superior Court of Québec gave very clear directives. We must have the courage and vision to apply these directives and support this bill in principle, because it deserves to be improved in committee.

The Baudouin decision in favour of Nicole Gladu and Jean Truchon is very clear: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu's rights to liberty and security, protected by section 7 of the Charter.”

We must read those last few lines carefully. They refer to the rights to life and freedom of choice. Which of us can presume to choose for someone else? I want to warn my colleagues against the temptation to think about themselves. I want to warn them against voting according to their own beliefs, philosophies or religion. Freedom to choose must be upheld, and in order to choose, we need options. The basis of the decision, which came after a very long wait and constant anguish, makes it very clear that this is about rights and freedoms. No one can choose for another person. We must remove the barriers so that everyone can live out their last moments in their own way, freely and without constraint. Of course, we must not fail to protect the most vulnerable, in accordance with the well-established rule, in medical practice, of free and informed consent. That means informed by exposure to all possible options, and free from any undue pressure.

This bill is a step in the right direction. It includes important precautionary measures and provides for the study of other important issues that need to be considered. Among other things, it would exclude people suffering solely from mental illness. I think that is a wise decision. This is an extremely complex issue that should be studied further. We cannot decide on this issue right now, hence the need to study it properly without skipping any steps.

We must also look at the issue of advance requests for persons newly diagnosed with a condition that may have an impact on their decision-making ability in the future. These are extremely sensitive issues that we must study with great care and a great deal of precaution. It is therefore wise not to include them for now.

Generally speaking, the purpose of this bill is to allow those suffering from degenerative, incurable diseases to have access to medical assistance in dying, whether natural death is reasonably foreseeable or not, except in cases of degenerative cognitive disease, as I was just saying.

For people whose death is reasonably foreseeable, this is about relaxing the rules by eliminating the 10-day waiting period between the written request and the administration of MAID. The 10-day waiting period may be waived if a person has been assessed and their request for MAID has been approved and arrangements have been made with their practitioner to obtain a waiver of final consent because the patient is at risk of losing their capacity to make a decision as the disease progresses or with the administration of pain-relief medication. That way, when making the request for MAID, the patient can agree to waive consent the second time if their pain is beyond treatment, even with care.

This last measure allows the person to live longer with a reasonable quality of life. The person therefore does not have to feel like they have to rush to request MAID out of fear of losing their capacity to do so.

For people whose death is not reasonably foreseeable, there is a 90-day delay between the request and the provision of the MAID service, unless assessments have been made and the loss of capacity is imminent. This time period must therefore be applied in a reasonable and reasoned manner. Who among us can guarantee that 90 days will be enough for some? Who among us can say whether 90 days will be too long a hell to endure for others? We are entitled to question the application of this delay. No one can say. That is why this clause and this entire bill will have to be implemented in a sensible, flexible and intelligent way. Practitioners are in the best position to determine what is valid and what is not when they work together with their patients, listen to them and, of course, treat them humanely. Ultimately, the priority must be the patients themselves, their well-being and their dignity.

I remind all members that although we are talking about dignity, this is above all about rights and freedoms. Every person at end of life must have options, and that individual is the only one who should be able to make that choice. We must not impose our own values and opinions. We must simply ensure that we provide a suitable framework regulating the practice of and the right to medical assistance in dying. We must respect the freedom of the individual. That is fundamental.

I urge all parliamentarians in the House to consider the huge responsibility we must shoulder. We hold in our hands the fate of hundreds of thousands of people. Not only is the end-of-life suffering of these people in our hands, but the suffering and anguish of their family members is as well. It is horrific to watch a loved one suffer at end of life and to feel helpless. Some members of the House may be thinking about personal choices. As I mentioned earlier, we need to figure out a reasonable framework for this very complex act and, through all of this, maintain freedom of choice for these individuals.

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

Madam Speaker, I thank the hon. member for his comments. I have some questions for him.

During the debates today and yesterday, a lot was said about some MAID practitioners. I would like to know whether the member heard the same concerns raised by the Conservatives about doctors who pressure patients too aggressively.

My second question has to do with the fact that mental illness is not included in the bill and that we will be studying it, as the member mentioned. I would like to hear his thoughts on the fact that the Government of Quebec also decided to study whether mental illness should be an underlying condition.

I would like to hear his thoughts on those two questions.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my hon. colleague. His questions are valid.

I will start by answering his second question.

With respect to mental illness, the Government of Quebec chose to study the issue more thoroughly before including it in the law. If two separate lawmaking bodies are making the same choices, that strongly suggests we are on the right path. I think it is a reasonable decision. Laws as impactful as MAID legislation must be drafted very carefully.

With respect to doctors' policies, I heard the horror stories some of our colleagues shared with the House. It is important to note that the medical profession is extremely well regulated. We need to make sure this bill provides a solid framework.

Some MPs shared examples of real cases with us, and I would encourage them to report those cases. I believe such cases are rare exceptions.

By far, most health professionals, including doctors, nurses and attendants, are dedicated to and care deeply about the well-being of their patients. They will take every possible precaution to ensure that the patient's choice is free and informed. As I said, for patients to make free and informed choices, they must be made aware of their options.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, the hon. member mentioned that much debate went on regarding euthanasia back in 2016, which obviously led to the current safeguards. Unfortunately, there has been absolutely no significant enforcement against infractions. The safeguards are regularly ignored. I have an example from the town hall that I held.

A constituent in my riding had a personal experience. A young married father with children was diagnosed with terminal brain cancer and had 12 months to live. He suffered depression, went to a psychiatrist and the psychiatrist offered him MAID. He immediately stopped going to that psychiatrist.

I would like to know why would we loosen the safeguards, which are clearly not working in the first place and seem to be completely impossible to enforce?

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my esteemed colleague for his question, which was also quite relevant.

I mentioned earlier that the law must include safeguards. However, this is not a matter of euthanasia but of medical assistance in dying. I believe that those are two fundamentally different things. It is clear that we will have to provide an appropriate legal framework.

I would like to add that this is why we need to take the time to examine the bill properly in committee. I encourage my colleague to raise those points in committee so that they are properly examined and to invite witnesses, including the people affected by this case. That will help us clarify this situation.

[Laurel Collins, NDP, Victoria, BC]

Madam Speaker, I want to thank the member across the way for highlighting the responsibility we as members of Parliament have in our choices, that we have a responsibility to reduce suffering but also ensure people do not end their lives before they want to and that Audrey's amendment would give people the opportunity to live longer and to make the choice.

I want to ask the member specifically about the 90-day requirement for that second track and the potential it has to prolong people's suffering.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I thank my colleague for her question.

That is why I took several minutes to talk about the 90-day period. Given the complexity of the decision that we will have to make, I think it is important that the law give the practitioner and the person the flexibility—

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

I am sorry to interrupt the member, but his time is up.

The hon. member for Shefford.

[Andréanne Larouche, Bloc, Shefford, QC]

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

Many MPs have very personal stories about the end of life of one of their loved ones. As the Bloc Québécois critic for seniors, it goes without saying that I have heard my share. Therefore, in my speech, I will recall the work done by the Bloc on this issue, the sensitivity that exists in Quebec regarding medical assistance in dying and, finally, the position of certain groups of seniors and women who have come to meet with me.

First, let me go over the context again. In September 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, both suffering from a serious degenerative disease, stating that one of the eligibility criteria for medical assistance in dying is too restrictive. This criterion, that of “reasonably foreseeable natural death”, is found in the federal government's Act to amend the Criminal Code and to make related amendments to other Acts with regard to medical assistance in dying, and the provincial government's Act respecting end-of-life care.

Justice Christine Baudouin said it well in her ruling when she wrote: “The Court has no hesitation in concluding that the reasonably foreseeable natural death requirement infringes Mr. Truchon and Ms. Gladu’s rights to liberty and security, protected by section 7 of the Charter.” Those two individuals had argued that they were being denied medical assistance in dying because their deaths were not imminent.

Let me now remind the House of the Bloc Québécois's position and highlight the outstanding work of the member for Montcalm, to whom I offer my deepest sympathies. I want to thank him for the work he has done on this file because, as he quite rightly pointed out, legislators did not do their job properly with Bill C-14. As a result, issues of a social and political nature are being brought before the courts. We need to make sure that people who have serious, irreversible illnesses are not forced to go to court to access MAID. That would be terrible, and yet that is what will happen if we cannot figure out a way to cover degenerative cognitive diseases.

However, we believe that it is important to be very cautious before making any decisions on questions related to mental health. That is why we are relieved that the bill does not address eligibility for MAID for individuals suffering solely from a mental illness. Indeed, this issue requires further reflection, study and consultation, which will be completed at the Standing Committee on Health as soon as the motion moved by my colleague from Montcalm is adopted.

For the second part of my speech, I would like to talk about Quebec's sentiments on this whole issue. Quebec was the first jurisdiction in Canada to pass legislation on medical assistance in dying. Wanda Morris, a representative of a B.C. group that advocates for the right to die with dignity, pointed out that the committee studying the issue had the unanimous support of all the parties in the National Assembly. This should be a model for the rest of Canada.

Ms. Morris said she felt confident after seeing how it would work in Quebec and seeing that people were pleased to have the option of dying with dignity. The Quebec legislation, which was spearheaded by Véronique Hivon, was the result of years of research and consultation with physicians, patients and the public. It has been reported that 79% of Quebeckers support medical assistance in dying, compared to 68% in the rest of Canada.

In 2015, when the political parties in the National Assembly unanimously applauded the Supreme Court ruling on MAID, Véronique Hivon stated:

Today is truly a great day for people who are ill, for people who are at the end of their lives, for Quebec and for all Quebeckers who participated in...this profoundly democratic debate that the National Assembly had the courage to initiate in 2009....I believe that, collectively, Quebec has really paved the way, and we have done so in the best possible way, in a non-partisan, totally democratic way.

For the third part of my speech, I would like to tell you about a meeting I had with the Association féminine d'éducation et d'action sociale, or AFEAS, in my role as critic for seniors and status of women. During the meeting, the AFEAS shared with me its concerns with MAID. I will quote the AFEAS 2018-19 issue guide:

Is medical assistance in dying a quality of life issue? For those individuals who can no longer endure life and who meet the many criteria for obtaining this assistance, the opportunity to express their last wishes is undoubtedly welcome. This glimmer of autonomy can be reassuring and make it possible to face death more calmly....As the process for obtaining medical assistance in dying is very restrictive, those who use it probably do so for a very simple reason: they have lost all hope....This process cannot be accessed by individuals who are not at the end of life....People with degenerative diseases, who are suffering physically and mentally, do not have access to medical assistance in dying.

Many people are not eligible for MAID because of the federal law governing the practice, which was imposed by a court ruling in February 2015. Four years after Carter, individuals whose quality of life is severely compromised by degenerative diseases are still being forced to ask the courts for permission to end their suffering.

In February 2015, the Supreme Court even struck down two sections of the Criminal Code prohibiting Canadian doctors from administering MAID. In Carter, the highest court in the land stated that a competent adult who clearly consents to the termination of life is eligible for MAID if that person “has a grievous and irremediable medical condition...that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

According to the AFEAS, the Supreme Court's criteria were very broad. In drafting the MAID eligibility criteria, the Government of Canada included the concept of reasonably foreseeable natural death only for people at the end of life, which excludes a significant number of people who are experiencing intolerable physical and mental suffering.

The entire process is based on the intensity of the suffering as assessed by a doctor and a panel of experts. The sick person's own assessment is not always taken into account. There are no compassionate criteria among the requirements for obtaining MAID. A person may be at the end of their life and be unable to make the request themselves because they cannot communicate. The law applies only to people who are able to give their free and informed consent up until the very end, which could be terribly traumatic and even cruel to those who have been suffering for years.

With regard to advance consent, the AFEAS spoke about the case of Audrey Parker, a woman from Halifax who died with medical assistance on November 1, 2018. She made a video three days before her death. In that three-minute video, she said that she would like nothing more than to make it to Christmas, but that if she became incompetent along the way, she would lose out on her choice of a beautiful, peaceful and, best of all, pain-free death.

The Barreau du Québec believes that the law should be amended to comply with the criteria set out in Carter and thus prevent court challenges from being filed by people who should not have to carry such a burden.

A panel of experts has studied this issue and recommends, under certain conditions, ending the suffering of patients who have previously expressed their wish to receive medical assistance in dying, but who subsequently become incapable of expressing their consent, in particular people with various forms of dementia or cognitive loss such as Alzheimer's disease. This is why AFEAS is asking, with respect to human rights, that the process of medical assistance in dying be based more on the rights of individuals and on respect for their wishes.

With respect to reasonably foreseeable natural death, it requested that the reference to “reasonably foreseeable natural death” be removed from the eligibility criteria. With respect to advance consent, it asked that the person's informed consent be respected and that it be given in advance. Also on the subject of advance consent, it asked that the consent anticipated, stated and recorded by the person be recognized.

In conclusion, today's debate demonstrates the need to act so that people suffering from degenerative and incurable diseases are no longer forced to go before the courts to challenge the terms and conditions surrounding eligibility for medical assistance in dying, and so that we can ensure the best possible continuum of care.

Let's take action so that everyone can die with dignity.

[Bardish Chagger, Liberal, Minister of Diversity and Inclusion and Youth]

Madam Speaker, I support a number of the comments made by the hon. member opposite. I support moving this bill forward and sending it to committee so that members can study it in depth.

I am wondering what advice the hon. member would give to people concerned about or opposed to this bill.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for her question. First, we have to listen to them. As already mentioned, if there are cases and concerns, we have to be able to document them and submit them to the committee. I will be meeting next week with a group that has concerns about this bill. I will listen to them and try to reassure them because I believe that there is a broad consensus that this bill must move forward.

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

Madam Speaker, I want to ask specifically about one issue my colleague did not address in her speech, which is the issue of the 10-day waiting period.

The existing framework involves a 10-day reflection period. The value of that is that people who are maybe at a particularly low point do not make the decision and then go through with the decision in a short period of time. There should be a mechanism, a time period, to ensure that they really are intent on moving forward with it.

At the same time, the existing system already has a mechanism by which this reflection period could be waived. In extreme circumstances it could be waived, but generally speaking, the 10-day reflection period ensures that people are not pressured into it in a short space in time.

Would the member be willing to support the idea of maintaining that 10-day reflection period in order to protect vulnerable people who might be pushed through this decision too quickly?

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his question. We are talking about the second consent, which we do not agree with. We believe that, in some cases, 10 days is already too long. It is a long time to suffer. In the case of advance consent, there is a way to avoid the 10-day period, which can be too long for some people.

[Laurel Collins, NDP, Victoria, BC]

Madam Speaker, many Canadians know someone who has experienced intolerable suffering, and most Canadians support these changes.

I am curious about one piece of the legislation, which is that people will be required to have two practitioners, one having expertise specifically in the medical condition that the person has. I am curious to hear the member's thoughts on the barriers that people from rural and remote communities might face, given this requirement.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, death knows no borders. As already mentioned, we must ensure that there are no obstacles in rural areas. We will have to examine all the obstacles that prevent equal access to a dignified end for everyone, no matter their postal code.

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

Madam Speaker, I would like to thank the member opposite. I want to ask a question regarding a point raised once again by the member for Sherwood Park—Fort Saskatchewan, who talked about patients being pressured and the possibility of doctors influencing people. The evidence that we examined during our consultations does not support that position.

I wonder if the member has any information on how the medical profession operates in Quebec. For our part, we found that doctors always show great professionalism, vigilance and circumspection when broaching the subject with patients.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I thank my colleague for his question. Personally, I have heard more about doctors showing a great deal of compassion for their patients and wanting them to be able to end their lives with dignity than the reverse. Personally, I have not heard of many, or really any, cases of undue pressure. Doctors take the Hippocratic oath, which provides patients with a great deal of protection.

However, just because I have not heard about something does not mean it does not exist. If it ever does happen, it must be reported. That could be discussed in committee. I think we need to let doctors do their job, which is about compassion more than anything else.

[Anthony Housefather, Liberal, Parliamentary Secretary to the Minister of Labour]

Madam Speaker, I will be sharing my time with the hon. member for Pontiac.

I want to start by saying that this subject is no doubt difficult for many Canadians watching. It is one in which we try to reconcile our deeply held view that life is precious with the right to liberty and the right to make our own independent decisions. This is a place where parliamentarians need to reflect not only on our own values but on what our courts have said.

In the Carter decision, the Supreme Court determined that section 7 of the charter meant that our provisions in the Criminal Code on assisted suicide were invalid. It said there was a class of people who were entitled to have doctors and nurses assist them in dying, so in 2016, Parliament had to move forward with legislation.

I had the pleasure of being the chair of the Standing Committee on Justice and Human Rights at the time. I listened to witnesses who had a myriad of opinions. I listened to professionals from all sides, including doctors, nurses, psychologists, people representing the disabled, and groups that advocated the right to die with dignity. What we crafted was a law that attempted to bridge all of those gaps. We knew that this law would not be in place forever. We knew that we, as a society and a country, would learn from the experiences of that law and that we would move forward with changes.

Indeed, I was very pleased that the Standing Committee on Justice and Human Rights made some significant changes to the legislation. We carved out conscience protection for medical professionals so that they were not obliged to assist with medical assistance in dying if it violated their own conscience or their moral values. We said that the law needed to be looked at again five years later to look at various classes of people we had left out of the original law, such as mature minors and people suffering from mental illness, as well as to examine the issue of advance directives whereby people could make decisions before they declined into dementia.

We also required the review to look at palliative care and its availability across Canada, because the two issues are intrinsically tied together. We do not want people to ever make a decision that they need medically assisted death because they will be deprived of proper palliative care.

That review is coming up. I know that Canadians across the country will have the opportunity to pronounce on these issues.

However, our courts have made another decision.

In the Truchon-Gladu ruling in Quebec, the court ruled that a class of people were entitled to access medical assistance in dying in accordance with Carter. The legislation passed in 2016 had removed this class of people from the list of people eligible for medical assistance in dying. We must therefore remove the section that limits medical assistance in dying to people whose death is reasonably foreseeable. This amendment to the original law is designed to remove this class of people and to enable people who meet all of the other criteria to access medical assistance in dying, even if their death is not reasonably foreseeable.

I support that position because I have not only looked at the court decisions but have also walked the experience of Canadians over the last four years.

We have heard of people who were enduring grave suffering and who should have been entitled to medical assistance in dying because they met every aspect of the law, except that no one could say with reasonable certainty that their death would happen in the near future. We heard, from Canadians everywhere in Canada who fall under that class, that this is unfair. The courts in the Truchon case and in a number of other cases have hinted that this requirement is unconstitutional, so the government is moving forward to respect the court's decision in Truchon and remove from the law the requirement for death to be reasonably foreseeable.

However, the government is also adapting the law to deal with other difficulties that have arisen.

We never talked about, or if we did, it was rare, the issue of people deciding to prematurely end their lives because they were worried they would lose capacity at a future date. People should not shorten their lives because they are worried that a month later they will no longer have the capability or capacity to make that decision under the terms of the law. If it will give people an extra two or three weeks or an extra month with their family, we should do that.

Therefore, the law is being amended to allow people to offer consent to a medically assisted death even if they lose capacity, but it also establishes safeguards. In the event they get to that date and they no longer wish to have medically assisted dying, even if they have lost capacity, by any word, any gesture that is not involuntary, then the pre-consent will disappear.

I want to clarify this, because it has been talked about a great deal today. This is not an advance directive. These are people who already know exactly what their illness is, they are already suffering from this illness, they are in an advanced state of decline, they have no ability to relieve their pain by medical treatment reasonably accessible to them and they have, after being reviewed by two medical professionals and declaring before an independent witness, decided they want to offer consent to end their lives on a certain date, even if they have lost the capacity to consent.

This is a really important change, and I credit the government for doing so.

I also want to look at the issue of how we have handled that class of people whose death is not reasonably foreseeable. We have established a 90-day waiting period in that case. We have not made this something that could happen in the 10 days that was previously reflected under the law. We have done so with due seriousness. We understand the differences and the challenges that the issue poses for people when their death is not imminent.

For example, people could have a catastrophic event that occurs and their circumstances change suddenly. We want them to have a proper reflection period before moving forward with medically assisted dying. We also understand and have made the exception for those people who may lose the capacity to consent during that 90-day period.

The amendments to the bill reflect well where Canadian society has gone.

I do want to say that when we passed the legislation in 2016, very few jurisdictions around the world allowed medical assistance in dying. It existed in Belgium, the Netherlands, Uruguay and five or six U.S. states.

We were one of the first countries in the world to allow medical assistance in dying. For that reason, we chose to take things slowly.

This new amendment to the original law takes us to a place where Canadian society has moved. Canadian society, much more than in 2016, accepts and supports medically assisted dying, because they have watched the practice happen. We have seen the challenges we have confronted with the existing law and we have taken steps to improve the law and comply with the Truchon decision.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

Madam Speaker, we hear that the current Liberal government is not aware of any infractions against the current euthanasia safeguards.

I have mentioned a few today, but I would also like to include the very public story of Roger Foley, who became a national story after being offered, repeatedly, by his hospital care workers euthanasia rather than suitable home care.

The current safeguards are not working. Why would we even start to loosen restrictions when we clearly cannot enforce the ones we already have?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I have faith in health care professionals across Canada, including nurses and doctors. I believe that the great majority of physicians and nurses in the country are dedicated professionals who do their jobs appropriately and follow the law.

In those cases where physicians or nurse practitioners have violated the law, I strongly suggest that members report them to the professional order of their province and to the police, and justice should prevail.

I clearly agree that medical assistance in dying is a decision of the person, but it is a decision of last resort. I believe palliative care is a priority, and everyone should have access to good palliative care in the country.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Madam Speaker, I commend my colleague for his thoughtful speech.

I would like to give him the chance to elaborate on the 90-day period he was referring to, as opposed to the 10-day period. We are all aware that each situation will be vastly different, including when it comes to capacity and the deadlines people are facing. We all want to avoid having a person die too soon out of fear of not being able to provide clear consent at a later date.

In my colleague's view, what sort of flexibility might be included in the 90-day period?

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, I greatly appreciate my colleague's question. I also commend him for his speech.

In my view, we must make a distinction between people whose death is reasonably foreseeable and those whose death is not reasonably foreseeable. I believe the 90-day period could be 75 days or 120 days. I believe that 90 days is a good compromise, but there is an exception. For people who obtain all the necessary authorizations from a doctor to have access to medical assistance in dying and who will lose the capacity to consent, there is an exception in the legislation that allows the waiting period to be shorter than 90 days. I believe that is a good step forward. I imagine we could propose amendments on this at the Standing Committee on Justice and Human Rights. Those amendments will be studied by the committee.

[Richard Cannings, NDP, South Okanagan—West Kootenay, BC]

Madam Speaker, the NDP is relatively happy with the new bill. We think it should have been done this way in the first place, four years ago.

One of the concerns we have, and this was also brought up by the Liberal member for Beaches—East York, is that with this new track for people who experience intolerable suffering, they will have to get an opinion from a specialist. Specialists are not easily seen in many parts of Canada, rural and northern parts. These are people at the end of their lives and intolerably suffering.

We are worried this will restrict the ability of these Canadians to have the same medical service other Canadians have.

[Anthony Housefather, Liberal, Mount Royal, QC]

Madam Speaker, in 2016 at committee, the requirement to see a specialist was suggested by a number of the groups that appeared. It would be a specialist in the area of the condition the person had.

Concerns were expressed that two doctors, or a nurse practitioner and a doctor, who did not have expertise in the condition would not be able to properly assess the individual. When we are talking about people whose death is not reasonably foreseeable, I do not believe this is outside the bounds. This is a reasonable way to approach the situation. With video conference and consultations, there are ways to reach remote communities. The person does not have to be in the room with the patient.

[William Amos, Liberal, Parliamentary Secretary to Minister of Innovation]

Madam Speaker, I am pleased to rise on the topic of Bill C-7, as we embark on what I expect will be quite a lively and passionate discussion about issues that Canadians care deeply about and certainly my Pontiac constituents. I heard from them for several years on this topic, regular correspondence, regular discussions at the door, so I appreciate this opportunity to discuss certain aspects of our government's proposed changes to the federal MAID legislation.

It is timely to share some of the insights from three important studies on very complex and sensitive issues that were not included in the 2016 federal legislation. These are requests by people for whom mental illness is their sole underlying medical condition, advance requests and requests by mature minors. I hope we will get to all three of them, but may only get to the first two.

When Bill C-14 was debated in 2016, parliamentarians had difficulty finding common ground on how to address these types of requests within Canada's first assisted dying regime. Understandably, given the challenging nature of these issues and the limited time that was available, due to the Supreme Court's timeline, to deliver on acceptable approaches for Canada, parliamentarians collectively decided that more in-depth study and review of the evidence was needed.

The legislation in 2016 therefore included requirements for the government to undertake independent reviews. There were strict timelines set out in Bill C-14 and the studies that needed to be commissioned had to be done within six months of the coming into force of Canada's new legislation on assisted dying and the government was obliged to table the final reports on the studies within a further two years. Both of these timelines were met.

In December 2016, the government asked the Council of Canadian Academies, CCA, an independent organization that undertakes evidence-based expert study, to inform our public policy development and to take on these studies that were required by legislation. The resulting reports were tabled in December 2018, documenting extensive review of academic and policy research, stakeholder submissions and international experience in the three subject areas.

They also included a broad range of perspectives from relevant health care professions, diverse academic disciplines, advocacy groups, indigenous elders, essentially the whole of Canadian perspective was brought to bear. In accordance with the CCA practice, they did not in fact contain recommendations.

Two of the reports, one on request by individuals where mental illness is the sole underlying condition and the report on advance requests have been particularly informative during the development of our government's response to the Quebec's Superior Court decision in Truchon.

I will first talk about mental illness. Under the current law, very few persons with mental illness as the primary source of their suffering are likely to be eligible for MAID. This is because most mental illnesses do not cause a person's natural death to be reasonably foreseeable.

Removing the reasonably foreseeable natural death criterion introduces the possibility for persons with mental illness to be deemed eligible for MAID, if they meet the remaining criteria.

During the recent federal round-table consultations held on MAID, we heard many concerns from participants who felt that not enough is known to safely extend eligibility for MAID to people whose suffering is caused by a mental illness alone. They felt that the issue required further examination.

We also know that there is generally very little support for expanding eligibility among mental health care practitioners, such as psychiatrists and psychologists, and by organizations representing people with mental illness. The CCA report on this issue noted a number of challenges associated with the delivery of MAID to persons with a mental illness.