Debates of Feb. 27th, 2020

Criminal Code

[Paul Manly, Green, Nanaimo—Ladysmith, BC]

Mr. Speaker, listening to the debate today, one of the things we need to do as a Parliament is to make sure we have national standards for palliative care and a national mental health strategy that ties the provinces to the Canada Health Act and makes sure provinces spend money in these areas, so that those are not concerns going forward with this act.

My question is about the final consent waiver, proposed subsection (3.2). It seems that it is tied directly to entering an agreement in writing with a medical practitioner or a nurse practitioner. That medical practitioner or nurse practitioner would administer a substance to cause the patient's death on a specific date. I am just wondering whether it is actually tied to that practitioner or whether it could be transferred to another practitioner, in the case where that medical practitioner with whom the patient made the agreement is unable to go forward with those wishes at that time, when the patient needs medical assistance in dying.

[William Amos, Liberal, Pontiac, QC]

Mr. Speaker, I must confess that is an aspect of this bill that I do not know enough about. I am going to have to go back and discuss that with the Minister of Health and the Minister of Justice because it does raise an interesting question. Canadians do have access to different health practitioners. Rather than saying something that I do not know much about, I would rather reserve comment, thank the member for his question and then have a discussion with him separately.

[Jean-Yves Duclos, Liberal, President of the Treasury Board]

First of all, Mr. Speaker, I would like to thank the hon. member for Pontiac and congratulate him for his great sensitivity, his ability to listen and his deep sense of humanity when he speaks to this very important issue.

I would like to quickly ask him to talk about the twofold objective we want to achieve, namely the protection of vulnerable people and access to greater dignity through greater freedom of choice for those who are experiencing tremendous suffering.

[William Amos, Liberal, Pontiac, QC]

Mr. Speaker, I thank my esteemed colleague for his question. This certainly is a very sensitive subject. It is a complex and deeply personal issue.

That is what comes through when I talk to people in the Pontiac. Everyone is concerned not only about their own future and their own health, but also the health and future of their family members and loved ones. We need to strike a balance between societal needs. The Government of Canada remains committed to protecting vulnerable individuals on the one hand and every Canadian's right to equality on the other. We need to safeguard eligible individuals' autonomy in requesting MAID. We also have to protect families and individuals who are not competent to make that decision. It is not easy. I am proud of our government for bringing in legislation on this issue.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I will be sharing my time today with my colleague, the member for Saskatoon West.

As a new member of the justice committee, I look forward to the issues that we will be dealing with in this new Parliament. While I am not a lawyer, nor do I have any desire to become one, I hope my contributions and insight on the issues of the day will help in rebuilding trust in our judicial system.

I am fully aware that many Canadians have serious concerns. Many are looking for solutions that will keep our communities safe, and they want us to begin the process of rebuilding the public's confidence in our justice system.

The legislation we are dealing with today is about one of those issues that almost every Canadian has heard of and will be, undoubtedly, following in the news. As a member of the Conservative caucus, I can debate this legislation and vote on it as I see fit. It is my intent to improve this legislation and to do the best I can in representing the good people of Brandon—Souris.

Like many Canadians, I find discussing the implications of medical assistance in dying challenging. There is no sugar-coating the fact that, for many people, it is extremely difficult to openly discuss the issue of death. As a result of to the Carter decision, it was left up to Parliament in 2016 to determine the appropriate legislative response in order to be compliant with section 7 of the charter. It must also be said that the Carter decision was specifically limited to a competent adult who gave her consent in receiving medical assistance in dying.

When we were seized with dealing with the legislation, many members of Parliament felt the government's response did not go far enough. One of the Liberal MPs who voted against the legislation was none other than the Minister of Justice. Some members were quite concerned about the lack of clarity, such as in the term “reasonably foreseeable”, which was left undefined. Other members wanted Parliament to supersede the Carter decision.

Disagreement is not new in this place. It is to be expected in Parliament, with members from all political stripes and backgrounds. I would argue that our democracy is much better served having such divergent views as to guarantee that every position is fleshed out.

When we debated Bill C-14, our Conservative caucus studied the legislation with the rigour that Canadians demanded of us. We asked the tough questions, we put forward amendments and we did what we were sent here to do, which was to ensure the concerns of our constituents were put front and centre. It is my sincere hope that we once again invest the necessary time on this and be as inclusive as we can so that all Canadians have their say on Bill C-7.

It goes without saying that there are deep divisions on the overall issue of medical assistance in dying. I know every member of Parliament is hearing from constituents on this issue, and in the past couple of weeks numerous petitions have been sent to all members' offices. I would also note that in the election, I received inquiries on the future of the legislation and on whether Parliament would be reviewing it anytime soon.

One of the elements in the original legislation was to have an automatic review, which will be undertaken this summer. It is notable that the legislation now before us has pre-empted the automatic review on a few matters. This upcoming review will be far more comprehensive than the two-week online survey used for Bill C-7.

From what many were expecting, the legislation that was set to be introduced was to respond to the Superior Court of Quebec's ruling. We now know that this is not the case. In fact, yesterday during debate, the parliamentary secretary of justice acknowledged that the Liberals did go above and beyond, because that is what he thinks Canadians want. While that may be his opinion, it is concerning that the larger changes found within Bill C-7 could have been dealt with in the larger review this summer.

What we are debating today has numerous changes that go much further than deleting and replacing the phrase “reasonably foreseeable” in order to be compliant with the recent court decision. For example, the government is easing safeguards, which I might add is the actual language found within the presentation with which departmental officials briefed MPs.

As it stands, patients must make a written request for MAID that is witnessed by two independent witnesses. In Bill C-7, this has been changed to one independent witness. I believe it is incumbent on the government to justify this change and to outline the rationale for why it needed to be amended. The government is also removing the mandatory 10-day period after the written request is signed. Once again, this is a significant change that goes above and beyond what was required for the law to be in compliance with the Quebec Superior Court decision.

It is my intent to invite as many experts, health care professionals and provincial governments to committee to ask them about the proposed changes and to determine if they are in fact needed. We must be cognizant that MAID still has the necessary safeguards in place to protect the vulnerable.

I want to put on the record that many of the issues we raised in the last Parliament, such as enshrining conscience legislation in law for medical practitioners, has fallen on deaf ears. This was an almost universal position among my Conservative colleagues, and the Liberal government of the day did not adopt those measures.

We were also quite adamant about improving access to palliative care. Even though the delivery of health care falls under the purview of provincial governments, we passed a private members' bill to implement an action plan. My colleague from Sarnia—Lambton, who worked hard to get this legislation passed, is very disappointed that the government's five-year action plan failed to commit enough resources or outline a clear set of measurable outcomes. In a rural riding like mine, there are not enough palliative care services available. My heart goes out to those families who must send loved ones to a different community in the final days of their lives.

As a champion of rural Canada, I know first-hand the unique challenges that millions of people face every day due to their isolation or remoteness. I want to give the benefit of the doubt to the government that it is committed to rural Canadians, but its record says something completely different. While these issues cannot be fixed in this legislation, we cannot treat them in isolation while discussing MAID.

In closing, I want the government to know I am committed to working with it constructively on this legislation. I will ensure that the concerns of my constituents are heard. We know there is nothing more precious than the gift of life: to live freely, to live safely and to live healthy and happily. It is our collective responsibility to do what we can to improve the quality of life of all Canadians.

I look forward to what my colleagues have to say on this legislation, and if it is sent to our justice committee, we will do our due diligence to listen to witnesses and improve it where possible.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Economic Development and Official Languages (Canadian Northern Economic Development Agency)]

Mr. Speaker, I enjoy working the member on the Standing Committee of Parliamentarians of the Arctic Region. He gave a very positive speech.

I wanted to reply to a couple of items. Why now, before that major review of the act in June? We had no choice; the Supreme Court ordered it. Concerning the 10-day period, medical practitioners suggested that a person may be incapable in those 10 days, so it was not necessary. That was a bit problematic, as was getting two signatures.

On palliative care, I agree 100% with the member. That is one of the reasons why in the last budget, for the first time in history, we added $6 billion to help the provinces with palliative care. I hope it is working toward exactly what the member would like.

Could the member let me know, as I think about this bill, what his constituents said to him about the MAID legislation?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, my colleague from Yukon and I have worked together on the Standing Committee of Parliamentarians of the Arctic Region for a while. Someday I will have to go up to Whitehorse to see how he operates.

The people in my riding have given me differing directions on this particular issue. As I said in my speech, there are many people with different ideas on how this should be done and on whether it should be done at all. I have received petitions from hundreds of people on both sides of this issue.

We will be listening intently, and as I said, if it comes to the justice committee, which I am a member of, we will be looking for input from the witnesses in the way I outlined and making sure we improve the bill wherever we can.

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

Mr. Speaker, I want to thank my colleague for his speech.

I would like to know why my colleague does not like the idea of having a single witness present while MAID is being administered. Usually, at this important time in their lives, sick people are surrounded by family members, and therefore by love and affection.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, the only thing I can say on that is that the two signatures acted as a safeguard. That was in place before, and now it would be one. There is also a shortening of the time frame for the reflection period. I think we need to hear from witnesses as to whether that should have stayed where it was or gone forward, but the government has put it in the bill to move it in that direction. I am not saying that one witness is not enough. I am just saying that the safeguards need to be in place to protect those who are vulnerable.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, obviously the original medical assistance in dying legislation was about limiting the amount of unnecessary suffering when people are facing end-of-life issues, both for the individual and for the families.

One part of the legislation that has been brought forward has been referred to as “Audrey's amendment”, named after Audrey Parker, a woman in Nova Scotia, who felt forced to choose an earlier death than she would have liked and ended up missing a last Christmas with her family because she felt she might lose competence and not be able to give consent at the end.

The bill that has come forward provides that those who have been assessed and approved can give instruction to a doctor so that if they lose competence before their wishes are carried out, they can receive assistance and not have to make the ugly choice to go sooner than they would like. Does the member support that provision?

[Larry Maguire, Conservative, Brandon—Souris, MB]

Mr. Speaker, I want to assure my New Democrat colleague that this is an area of concern. There is no doubt that the situation he outlined is of great importance in determining the situation before us. It will be coming back to our committee. I look forward to working with him on it as well, as he is a member of the justice committee.

At this point I want to make sure we hear from as many witnesses as we can. I have already heard from many in my area who are quite supportive of that and of having the 90-day before going forward. This is one of the changes to “reasonably foreseeable” put in the bill, and I support the part of the bill that would allow them to do that.

[Brad Redekopp, Conservative, Saskatoon West, SK]

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.

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

Mr. Speaker, given the preamble in the old Bill C-14 expressly references conscience protections, given that section 241.2(9) of the Criminal Code, which was amended by his party at his party's suggestion in the last Parliament, also has conscience protections, given that paragraph 132 of the Carter decision references conscience protections and given that the section 2 protection in the charter is a bedrock foundational conscience protection, does the member, first, think that is sufficient with respect to conscience protections?

Second, is there any instance of an institution, of religious persuasion or otherwise, being forced to provide this, given those protections? I am aware of none.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, there are cases that I am aware of, to the member's last point. The reality is what happens on the ground. I have heard cases of people, medical professionals who do not want to participate and yet they felt harassed, pressured, criticized and those types of things. There are certain protections under the laws now, but they need to be strengthened, and in practice it needs to be expanded.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, I thank my colleague for his speech, in which he talked about rights and freedoms.

I just want to know if he is aware of the ruling regarding Nicole Gladu and Jean Truchon, both of whom have degenerative diseases, in which Justice Christine Baudouin wrote that, “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.”

I would like to hear my colleague's thoughts on that.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, yes, I am aware of that. That is the part that I believe we should be pursuing now. The other changes that have been proposed, regarding the waiting period and some of these other things, should not be pursued now. The bulk of what is being proposed should wait until the consultation period in the summer. We need to deal with the request from the Quebec court and the ruling from the Quebec court. For the rest, I believe we should wait.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Mr. Speaker, I would like to talk about something that happened just a few minutes ago. Someone I know quite well contacted me, someone who is not currently eligible for medical assistance in dying under the legislation and would probably qualify under the new provisions. This person is in intolerable pain and suffering and has reached out to many people, asking for help.

I believe the reason the government has decided to proceed with some of these changes is to meet that need and help us reduce unnecessary suffering at the end of life. This is not someone who is being pressured. This is someone whose condition is deteriorating quite rapidly and is, as I said, in enormous pain. I ask the member to think about that motivation here for us to reach out and help those people and those families who are faced with this right now, not months from now.

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, we can all think of many specific cases of people who are impacted by this. I still believe it is correct to wait for the review process to look at all these cases and make changes based on that.

The other issue that the member's question raises is the lack of palliative care. If there were more and better palliative care options, while I do not know about the specific case the member mentioned, then more people would have other options than MAID. I believe, though, that is another solution.

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

Mr. Speaker, in this debate, we hear that the safeguards we currently have are already not working. We know that quality palliative care is a necessary solution and we all see a lack of access, even a revocation of palliative care in my province.

The third thing is, unfortunately, the inability to ensure conscience rights protection. In my province of B.C., the former program director of palliative care had to resign when Fraser Health Authority imposed MAID in hospices. He believes that palliative care does not include euthanasia since palliative care, by definition, neither hastens nor postpones death.

Why is the government not working harder to ensure proper protection for patients and health care professionals?

[Brad Redekopp, Conservative, Saskatoon West, SK]

Mr. Speaker, that raises some very good points. It raises the issue of institutional conscience protection, and also the issue of better palliative care options in our country. Those are areas that we need to pursue just as vigorously as the government is pursuing the MAID legislation.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of International Development]

Mr. Speaker, it is an honour to rise in this House to speak today about Bill C-7. This bill would amend the medical assistance in dying regime in the Criminal Code to address the Superior Court of Quebec's decision in the Truchon case. As members know, in September 2019, the Quebec Superior Court struck down the eligibility criterion of “reasonably foreseeable natural death” from the medical assistance in dying, or MAID, regime in the Criminal Code. Our government has made significant efforts to consult and engage with Canadians in order to inform the proposed approach to address this decision and amend the MAID regime in Canada.

An online consultation was launched, and over 300,000 responses were received from Canadians. In addition, the Minister of Justice and Attorney General of Canada, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion had the opportunity, along with their parliamentary secretaries, to meet with stakeholders and experts across the country during a series of round tables all over Canada. These consultations were an extremely important part of the development of Bill C-7.

Medical assistance in dying is a sensitive and challenging social issue that we are currently faced with, one that is deeply personal for very many people and for me personally. I worked as an oncology nurse at St. Joseph's hospital in Toronto and have seen end-of-life care first-hand. I have seen individuals making difficult end-of-life decisions for themselves or their loved ones, and I appreciate our government's decision to consult and listen carefully to Canadians on this issue.

In addition to being deeply personal, the issue of medical assistance in dying is also legally and ethically complex, which is why it was so important for our government to meet with experts, stakeholders and practitioners during the round tables. Our government listened. It listened to the health care experts, doctors, nurses, legal scholars and regulators, but most importantly, it listened to Canadians. The bill takes into account what was learned during these consultations and responds to the Truchon ruling by proposing amendments to the Criminal Code that would ensure consistency of the MAID law across the country by broadening eligibility, and adjusting the safeguards accordingly, for a MAID regime that is no longer limited to end-of-life circumstances.

Bill C-7 proposes to amend the Criminal Code in response to the Truchon ruling in three ways.

The first is by expanding eligibility to those whose natural death is not reasonably foreseeable but who are still experiencing intolerable suffering. This will give those who are suffering in a wider range of situations the choice of a medically assisted death.

At the same time, the amendments would exclude those suffering from only a mental illness. This is in response to very specific concerns voiced by experts and mental health professionals about eligibility on the basis of a mental illness. Many members will also recall that during the study of former Bill C-14, the government asked the Council of Canadian Academies to look into such cases. The experts in this field could not come to a consensus on this very complicated issue in their report on the subject, which was released and tabled in this chamber in December 2018.

Our government recognizes that the unique considerations for the availability of MAID for individuals experiencing suffering only from mental illness requires further discussion and public debate. I believe the parliamentary review that will begin in June 2020 is the appropriate forum for the further consultation and deliberation that are needed before considering any changes in this regard.

The second main feature of this bill is the creation of two sets of safeguards to be followed before medical assistance in dying is provided, depending on whether a person's natural death is reasonably foreseeable or not.

The bill would continue to use the expression “reasonably foreseeable natural death” as the element that determines which safeguards to use. This approach for a MAID request is consistent with the view that medical assistance in dying for people whose natural death is not reasonably foreseeable presents more complexity. Many experts believe that the assessment of a request should be tailored to these different types of cases.

New safeguards for those whose natural death is not reasonably foreseeable will focus on ensuring that assessments take adequate time and involve the relevant expertise to detect and address the sources of the person's suffering. They will also ensure that people receive information about the appropriate and available services and options to improve their quality of life. They will need to give serious consideration to those options before concluding that medical assistance in dying is the choice for them.

Finally, the bill would relax some of the existing safeguards, in particular for those whose natural death is reasonably foreseeable. Those whose deaths are reasonably foreseeable will not need to undergo the 10-day reflection period. These individuals have already given a lot of thought to their request before they made it, and requiring them to wait another 10 days after they have been approved for medical assistance in dying may prolong their suffering unnecessarily.

Just as importantly, the bill proposes to permit the requirement of final consent to be waived in the case of people whose natural death is reasonably foreseeable when certain conditions are met. These conditions are that the patient's death must be reasonably foreseeable; they must have been assessed and approved for medical assistance in dying in accordance with all safeguards; they are at risk of losing decision-making capacity before their preferred date to receive medical assistance in dying; and they have a written arrangement with their practitioner, in which they have given consent in advance to medical assistance in dying being administered if they lose capacity, and in which the practitioner agrees to provide medical assistance in dying on their preferred date, or earlier, if they can no longer provide the final consent.

These proposed amendments would also clarify that practitioners would not be allowed, in this situation, to provide medical assistance in dying if the patient demonstrates refusal or resistance by words, sounds or gestures.

For individuals whose natural death is not reasonably foreseeable, the remaining criteria defining the grievous and irremediable medical condition in the Criminal code would expand eligibility to medical assistance in dying to people with a wide range of conditions. A grievous and irremediable medical condition is defined in the code as a serious and incurable illness, disease or disability; an advanced state of irreversible decline in capacity; or intolerable suffering that cannot be alleviated under conditions that the person considers acceptable.

This means that a grievous and irremediable medical condition could include conditions producing chronic pain or other symptoms. Canada's medical assistance in dying regime would move away from being an end-of-life regime to becoming a regime in which MAID could be chosen to relieve unbearable suffering that occurs outside of the dying process.

To conclude, the bill before us today proposes the amendments required by the Truchon decision. It also reflects what we heard in 300,000 responses to the online consultation. This is what we heard from stakeholders when the ministers and parliamentary secretaries held consultations from coast to coast to coast. It takes into account the opinions and input of health care professionals, doctors, nurses, legal scholars, provincial regulators, civil society, non-governmental advocacy organizations and those with lived experiences. The bill strives to achieve a balance between respecting personal autonomy and protecting vulnerable individuals. Perhaps most importantly, it respects the equality rights of all Canadians.

For those reasons, I call on the members of the House to support this bill, send it to committee where it can be looked at even more thoroughly and make this a reality in Canada.

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

Mr. Speaker, I want to comment and pose a question to the member around one of the strands in today's debate.

Members on our side have raised the need for safeguards because of the risk of abuse. Responding to an argument that was not made, government members have said they trust health care professionals to make good decisions in the vast majority of cases.

Of course, we also trust health care providers to make good decisions, to have good intentions and to do all they can to stay within the bounds of a patient's well-being in the vast majority of cases. However, the reason we have safeguards is to deal with that small minority of cases in which someone could actually lose his or her life as a result of pressure, as a result of a proper review not taking place, or as a result of being rushed into decisions in less than ideal circumstances.

We talked about examples of this small minority of cases in which human lives are still very much in the balance. Because of this need to have safeguards for these situations, would the member accept that a default to a 10-day reflection period would provide some degree of insulation against the possible risk of someone in a dark moment, in a short-term thinking process, opting for something that on balance they would actually not opt for with the proper engagement of their full support structure?

The 10-day reflection period can be waived in extreme circumstances already, so what is wrong with a 10-day reflection period?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I know this is very complex and a very personal issue. For those whose death is reasonably foreseeable, the bill proposes to eliminate the 10-day reflection period, 10 days that many practitioners say can prolong unbearable suffering. It is about patients and about the individuals and their rights.

The requirement for two independent witnesses, which many experts indicated created difficulties for certain types of patients, would also be eased for eligible persons. Health care workers would be able to act as independent witnesses, provided that they are not the provider or the assessor.

[Lloyd Longfield, Liberal, Guelph, ON]

Mr. Speaker, I thank the hon. member for Brampton West both for her speech today and for work as a health professional. Listening to her, I wonder what her patients must be thinking of her as she speaks now in the House on their behalf.

I have had many conversations with constituents who are facing the need to have this legislation improved. In December, I spoke to a person who had a best friend who was trying to access medical assistance in dying, and he also had a brother who was trying to access medical assistance in dying. The reasons that led them both to that were ultimately the pain they were feeling and the loss of independence and dignity, and not foreseeable death.

The voices that really resonate at the end of the day are the people who are trying to access services or family members who know their situation. It is important that we give priority to the voices of the people whose rights are being denied under the current legislation.

Could the hon. member comment on how important it is that we protect the freedoms of the people we are serving who are trying to access this type of service?

[Kamal Khera, Liberal, Brampton West, ON]

Mr. Speaker, I would like to thank my colleague for his ongoing advocacy on this issue, and we have had many conversations about it.

It is very personal for me to speak on this issue, as I have in the past when the debate on medical assistance in dying first came to this chamber in 2015. Just before the election in 2015, I was a registered nurse. I am still a registered nurse working in oncology, working with patients to provide them with palliative care and helping them during their end of life.

Those rights are what we are protecting today. I think the member in his question answered his own question, so I would like to thank him for that. I think the bill does just that. I hope that all members of the House pass the bill and take it to committee, where there may be some discussion on how to make it better.