Mr. Speaker, today I rise to speak on Bill C-7, an act to amend the Criminal Code regarding medical assistance in dying.
My office has received about 135 phone calls, emails or letters so far on this issue, and I recognize that this is a very touchy, personal and non-partisan issue.
I will begin with a quick bit of history. The MAID legislation came into law in June 2016. Recently, one judge in Quebec ruled that the wording in the legislation on “foreseeable death” was too restrictive. The Liberal government was very quick to accept this ruling. It chose not to appeal, and instead moved to rewrite the legislation taking into account the decision of the court.
This caused me to compare this ruling to the recent Alberta court ruling in which four judges found the carbon tax to be unconstitutional. It made me wonder if the government is going to be as quick to accept the Alberta court ruling as well and not appeal it, but that is a digression.
As I said, MAID is a very touchy, personal and non-partisan issue. One can always find examples of people for whom MAID legislation is a difficult but welcome option. Unfortunately, those simple examples are usually in the minority. Far more often, it is much more complicated than that. The stories I have heard reflect these complications, such as the case where families are caught by surprise with a death and then forced to deal with the aftermath of that.
There are cases where a person is at a particularly low point in their health but, under this proposed legislation, would be able to request and receive MAID with no waiting period. There are cases where physicians or hospital officials apply pressure on individuals to consider MAID. For example, Roger Foley, an Ontario man who is suffering from an incurable neurological disease, said that the medical staff repeatedly offered him MAID, despite his repeated requests to live at home.
There is also the B.C. case of Ms. S. Dr. Wiebe lamented the profound suffering of Ms. S. but felt that Ms. S. was not eligible for an assisted death. Then, unfortunately, Ms. S. decided to starve herself. Dr. Wiebe and another doctor then determined that, due to the severe malnutrition and dehydration of Ms. S., her natural death was reasonably foreseeable, so Dr. Wiebe euthanized her on March 2017.
According to a Globe and Mail article, this case is the first to be made public in which a medical regulator has ruled on the contentious question of whether doctors should grant assisted death to patients who only satisfy all the criteria of the federal law after they have stopped eating and drinking.
It is not difficult to imagine a situation where a hospital will, for reasons of efficiency, encourage its staff to suggest MAID to patients with chronically difficult and complex cases. It is not a simple problem. It is a very complex problem.
What bothers me about this is that the government is pre-empting the parliamentary review process that was specified in the legislation. We know that the current justice minister voted against the party on the original legislation because he felt that it did not go far enough. Now, as justice minister, he is able to make the changes that he desired. This is troubling, because he is choosing to pre-empt the legislated review process and get his desired changes into legislation without consultation.
The existing law mandates the review of the legislation every five years, and the review will happen in just a few months.
Why is the government is such a rush to make substantive changes to this legislation and pre-empt the legislated review process?
To me, it makes far more sense to deal with the specific issue raised by the Quebec judge only, then do a proper consultation with Canadians this summer and propose changes based on that. Instead, the government had an extensive online survey that lasted two weeks. While it received a lot of responses, I think it just proves that there is great interest, and Canadians have a lot to say about this issue. So far, the results of these responses have not been shared, and I ask for these responses to be shared. I call on the government to do the right thing and leave any changes beyond what the Quebec judge has asked for until the completion of the review process later this year.
Since we are talking about changes to this legislation, I want to talk about palliative care. There are calls for a pan-Canadian strategy on palliative care. I think it is convenient to point to the provinces and say that this is their problem, but there cannot be a full end-of-life strategy without funds and laws around palliative care.
The government broke a key election promise to invest $3 billion in long-term care, including palliative care. Access to palliative care is an essential part of end-of-life decision-making.
I have a personal example from Saskatoon, which has 12 palliative care beds for an area with over 300,000 people.
My mother-in-law had a terminal disease. In her case, MAID was neither requested nor desired. She was fortunate in that her death was relatively quick, and by some miracle she was able to get one of those 12 beds in Saskatoon.
It should not take a miracle to get good end-of-life care. It should not be that MAID is the only reasonable solution at the end of life because palliative care is not available. Therefore, I call on the government to put as much effort into palliative care as it has into MAID.
Another significant area of concern is conscience protection. Physicians and health professionals must be given strong conscience rights. They must be free to not participate and be free of penalty or harassment for making that choice. They must also be free to not be required to refer to another health professional. They must have full conscience protection.
Further, it must be recognized that the conscience objection of institutions must be protected. Institutions are not bricks and mortar. They are collections of people with values. Therefore, institutions must also be given the right of conscience protection. Several Supreme Court cases are instructive here.
The Supreme Court in 2015, in the Loyola case, stated:
Religious freedom under the Charter must therefore account for the socially embedded nature of religious belief, and the deep linkages between this belief and its manifestation through communal institutions and traditions.
In another 2015 decision, the Supreme Court stated:
A neutral public space free from coercion, pressure and judgment on the part of public authorities in matters of spirituality is intended to protect every person’s freedom and dignity, and it helps preserve and promote the multicultural nature of Canadian society.
We must respect the multicultural nature of Canadian society. We must respect both medical professionals and institutions, and allow them to have full conscience protections free from harassment and consequences.
There are some specific changes proposed that I am concerned about. The current legislation includes a 10-day waiting period between when MAID is requested and when it can be administered. The current legislation already allows for this waiting period to be waived. It states that if two medical practitioners:
...are both of the opinion that the person's death, or the loss of their capacity to provide informed consent, is imminent—any shorter period that the first medical practitioner or nurse practitioner considers appropriate [can be used] in the circumstances.
There already is a provision to deal with this issue. There is no need to make changes. The situation has been contemplated and addressed in the current legislation.
Another area of concern is the lack of safeguards for the mentally ill. Mental illness is a very complex situation. Patients diagnosed with an underlying mental health challenge are not required to undergo a psychiatric assessment by a psychiatric professional to determine whether they have the capacity to consent.
There is no one-size-fits-all solution to the issues of mental health. However, it is not difficult to imagine a scenario in which a person is in a particularly dark period and considers MAID. It may well be that with proper professional help that person can work through the darkness and emerge a bit better. This may not always be the case, but that is why having a general waiting period is so important. It eliminates the ability of medical professionals or others to make a quick decision that they regret.
A poll in January found that Saskatchewan and Manitoba had the lowest support in the country for MAID. In 2018, in Saskatchewan, only 67 of 172 applicants for MAID actually received medically assisted death. Some were declined, some withdrew and some died before the request could be completed.
In summary, I would make the following observations. Most importantly, in the words of a constituent I spoke with this week, “We need to slow this down, not speed it up.” Yes, we need to deal with the Quebec court decision, but that only requires one change. There is a legislated review that will happen this summer.
Let us wait for a proper consultation and use that lens to view any proposed changes. Let us have a pan-Canadian strategy for palliative care. Let us put full conscience protection in place for physicians and health care professionals. Let us put conscience protection in place for institutions. Let us leave the 10-day waiting period and the ability to create exceptions the way it is. Let us deal with the Quebec court decision and leave the rest until after the legislated review this summer. Let us slow this down.