Debates of Feb. 27th, 2020

Criminal Code

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I am pleased to join the debate on Bill C-7, an act to amend the Criminal Code, specifically section 241 of the Criminal Code. That is the provision of the Criminal Code that makes it illegal to counsel a person to commit suicide or to aid someone to do so.

In the absence of more recent amendments, in the previous Parliament there was Bill C-14 in response to the Carter decision by the Supreme Court of Canada. In that case the court found that the plaintiffs' charter rights had been infringed upon by a strict interpretation of section 241.

Interestingly, Bill C-14 from the previous Parliament stated, as one of its objectives in paragraph six of the preamble:

...permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons...on the other;

The relevant provisions in the Criminal Code included that language. It states that qualifications for MAID, including with respect to the person:

their natural death has become reasonably foreseeable, taking into account all of their medical circumstances....

All of this is about to change because of the Truchon decision.

I am speaking to Bill C-7, a bill that would eliminate the reasonable death forseeability safeguard and expand MAID, medical assistance in dying, to a larger number of people. I have been encouraged to speak to the bill because of the many letters and correspondence I have received from people in my constituency.

I have received some letters in support of expanding MAID, but the vast majority of the letters I have received encourage me to speak against expanding the availability of medical assistance in dying.

Correspondence that I am receiving from constituents repeat two basic themes. First is that the reasonable forseeability of death safeguard should be maintained as an effective defence of societal interests and Canadian values. Second is that more should be done to expand palliative care services.

To quote one person, let Canada be a society that is known for its modern and advanced palliative care services and not as a country that has ever expanding use of medical assistance in dying. We should alleviate the suffering, not eliminate the sufferer.

I am going to read quotes from two people who each made the effort to write me a letter.

The first is Dr. den Hollander, who states:

If Canada must allow MAiD in some form (and I wish it didn't), it is incumbent upon us to ensure that it is rare. Eligibility requirements should be tightened, not loosened. More safeguards are necessary, not fewer. Enforcement must be scrupulous, not relaxed. Without these protections, vulnerable people will be pressured by family members, friends and medical practitioners to MAiD.

The second is a woman named Ramona. She works in health care, including palliative care. She quotes a person to whose care she attended, and who died in the Langley Hospice facility, as saying, “I want to live well while I'm dying.” Ramona goes on to comment, “Surely this is what health care was created for, to support people while they are alive, not to speed up their death.”

This is the tenor of the input I am receiving from my constituents.

Behind Bill C-7 is the Superior Court decision in Truchon. The plaintiffs in that case argued that their constitutional rights had been infringed upon by the now amended section 241 of the Criminal Code. They argued that the Carter decision, on which Bill C-14 was based, did not require that a person's end of life be reasonably foreseeable, and that is a true statement. That is not what the Carter decision required.

Secondly, they argued that the legislated end of life requirement violated the right to equality, under section 15 of the charter, and the right to life, liberty and security of the person, under section 7 of the charter. The federal government, acting through the Attorney General's office, did the right thing at that time. It defended its law. That is what the Attorney General should do. Bill C-14 was the well-considered opinion of the previous Parliament. It was the law. The Attorney General must defend the law.

Remarkably, the Quebec Superior Court refused to accept the arguments advanced by the Attorney General. The Quebec Superior Court said that the court cannot accept the first two objectives advanced by the Attorney General regarding the affirmation of the inherent and equal value of every person's life and the importance of preventing suicide.

In the opinion of the justice writing that decision, those two principles were not the underlying philosophy of Bill C-14. It was all about protecting vulnerable persons from being induced, in moments of weakness, to end their lives.

Remarkably, the Attorney General of Canada did not appeal that decision. That is what should have been done. Any self-respecting Attorney General would appeal a decision that attacked the laws of Parliament. This Attorney General elected not to do that. Now we are in this position where we are under pressure to amend the law, when we should instead be following the directive of Bill C-14, and that is to have a comprehensive review of the whole legislation.

That is what we should be doing. What is the rush? The rush is caused by the Attorney General's failure to appeal this decision. It should have been tested through the court system, up to the Supreme Court of Canada.

With the reasonable foreseeability of death safeguard down, this is what we have left. An applicant for MAID qualifies if he or she has a serious and incurable illness, disease or disability; is in an advanced state of decline; or their physical or psychological suffering is intolerable to them, which is a completely subjective test. The reasonable foreseeability of death criteria is now gone.

Let us just test this against a couple of hypothetical situations. We can imagine that a person has Parkinson's or MS, or was in a terrible accident and is a paraplegic. Under this new regime, if it becomes the law, people who are not dying but who meet all the other criteria, however subjective they may be, will qualify for state-sanctioned suicide. One of my constituents has said that we should let Canada be a society that is known for its modern and advanced palliative care services, and not as a country that has ever-expanding use of medical assistance in dying.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I rise on a point of order, and I apologize to the member for interrupting his questions and answers.

Mr. Speaker, there have been discussions among the parties, and, if you seek it, I am hopeful that you will find unanimous consent for the following: That, notwithstanding any Standing Order or usual practices of the House, Bill C-4, an act to implement the agreement between Canada, the United States of America and the United Mexican States, reported back earlier today, be permitted to be considered by the House tomorrow at report stage.

[The Deputy Speaker, Conservative, Bruce Stanton]

Does the hon. parliamentary secretary have the unanimous consent of the House to propose this motion?

[Some hon. members]

Agreed.

No.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, in addressing the bill, the member opposite made reference to the fact that he was quite disappointed that the federal government did not appeal the decision from the Superior Court of Quebec.

Does the member feel that, if the government looks at a Superior Court ruling, it would be a viable option for the Government of Canada and the Attorney General to forgo going to the Supreme Court to appeal, and instead make the changes that are being requested?

That is why we see the legislation that we have before us.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, Bill C-14 was the well-considered response of the previous Parliament to a Supreme Court of Canada decision, the Carter decision. Bill C-14 became the law, it was incorporated into the Criminal Code of Canada.

I am of the opinion that the Attorney General should defend the laws of the country. The law was only three years old and was a well-considered decision of Parliament. The Attorney General should defend the laws of Parliament.

[Laurel Collins, NDP, Victoria, BC]

Mr. Speaker, can the member comment on whether the Conservatives support Audrey's amendment and helping families to avoid the kind of cruel suffering and difficult choices people often face when they are looking at imminent end-of-life situations and potentially not being able to give consent farther down the road?

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, I believe people should have choice, but choice should be a real choice. Palliative care is the right way to go. Somebody who wrote to me said that we should let Canada be known as a country of advanced palliative care, not as a country of an ever-expanding provision of MAID.

I understand people suffer and may not be able to give concurrent consent, however this country can certainly invest more money in advanced palliative care, which would relieve suffering to a very large degree. We should work on alleviating the suffering, not eliminating the sufferer.

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

Mr. Speaker, there are many different provisions in this legislation. One of them that I thought was interesting is that in the case of someone whose death is not reasonably foreseeable, the government is saying that one of the two physicians involved in the consultations has to have some expertise in the ailment. It is interesting because this did not appear in any of the other cases. It seems to me reasonable to have this safeguard not just for the case where death is not reasonably foreseeable.

In all cases, at least one of the physicians consulting should actually have some particular expertise about the ailment. Physicians deal with a wide variety of things, so the person who knows particularly well the disease should be involved in the consultation. To me, that seems very reasonable, and I wonder what the member thinks of that. I hope the government might be willing to apply this safeguard not just in one of the two streams, but across the board.

[Tako Van Popta, Conservative, Langley—Aldergrove, BC]

Mr. Speaker, it stands to reason that I would support anything that would improve and enhance informed consent. The doctor giving the advice to the suffering patient should indeed be an expert in the field. I would also support any argument that would put in that additional safeguard for both streams, patients whose death is reasonably foreseeable as well as those whose death is not reasonably foreseeable. It stands to reason I would support that, and I hope the government would support it.

[Irek Kusmierczyk, Liberal, Parliamentary Secretary to the Minister of Employment]

Mr. Speaker, I will be sharing my time with the member for Beaches—East York.

It is an honour to stand up in the House of Commons and participate in the second reading debate for Bill C-7, an act to amend the Criminal Code to Canada's medical assistance in dying legislation.

In developing these amendments, Canadians were widely consulted in January 2020. During these consultations, approximately 300,000 Canadians completed an online questionnaire. In addition, the Minister of Justice and Attorney General, the Minister of Health and the Minister of Employment, Workforce Development and Disability Inclusion met with stakeholders in Halifax, Montreal, Toronto, Vancouver, Calgary, Winnipeg, Ottawa and Quebec City to discuss proposed revisions to Canada's medical assistance in dying framework.

These experts and stakeholders included doctors, nurses, legal experts, national indigenous organizations and representatives of the disability community. The high level of participation in both the questionnaire and the in-person sessions is a reflection of the importance of this issue to Canadians. Moreover, the results of the consultations were critically important in shaping the government's approach to medically assisted dying as it evolves to reflect the needs of Canadians.

This bill would amend the Criminal Code to allow medical assistance in dying for people who wish to relieve their suffering through a medically assisted death, whether their natural death is reasonably foreseeable or not.

This bill would remove the reasonable foreseeability of natural death from the list of eligibility criteria. It would also expressly exclude people seeking medical assistance in dying solely because of mental illness.

The bill proposes a two-track approach based on whether a person's natural death is reasonably foreseeable. Existing safeguards remain and are eased for those whose death is reasonably foreseeable. In addition, new and modified safeguards would be applied to eligible persons whose death is not reasonably foreseeable.

In the spirit of “nothing without us”, I would like to mention the government remains focused on addressing the concerns of the disability community around vulnerability and choice. The proposed changes to the legislation support greater autonomy and freedom of choice for eligible persons who wish to relieve their suffering by pursuing a medically assisted death.

At the same time, full consideration has been given to the protection of vulnerable persons and to respecting the equality rights and dignity of persons with disabilities. In short, this bill would maintain and strengthen safeguards to support fully informed decision-making, while also respecting individual autonomy.

In terms of advance consent, many participants were comfortable with implementing advance requests for those who have been assessed and approved for medically assisted dying, but are concerned about losing capacity before it is provided. This bill would allow people who risk losing decision-making capacity to make arrangements with their practitioner to receive medically assisted dying on their chosen date, even if they lose decision-making capacity before that date.

The bill would also make advance consent invalid if the person demonstrates refusal or resistance to the administration of medically assisted dying. The bill goes on to clarify that reflexes and other types of involuntary movements, such as response to touch or the insertion of a needle, would not constitute refusal or resistance.

In addition, the bill would allow eligible persons who choose to self-administer to provide advance consent for a physician to administer a substance to cause their death if self-administration fails and causes them to lose capacity. This type of advance consent would be available for all eligible persons, regardless of their prognosis.

I would like to take a moment to speak to the progress the government has made with respect to the rights of persons with disabilities in Canada. In fact, last year, the government enacted the Accessible Canada Act, which aims to create a barrier-free Canada through the proactive identification, removal and prevention of barriers to accessibility wherever Canadians interact with areas under federal jurisdiction.

The act is one of the most significant advances in disability rights since the charter in 1982 and is designed to inspire a cultural transformation for disability inclusion and accessibility in Canada. The act created Accessibility Standards Canada, a new organization that will create and revise accessibility standards, and support and promote innovative accessibility research. The CEO and board of directors were appointed and operations began last summer.

That act also established National AccessAbility Week, a week dedicated to accessibility in late May and early June each year. National AccessAbility Week is an opportunity to promote inclusion and accessibility in communities and workplaces, and to celebrate the contributions of Canadians with disabilities.

It is also a time to recognize the efforts of individuals, communities and workplaces that are actively removing barriers to give Canadians of all abilities a better chance to succeed. The act applies to federally regulated organizations for now, but we know the culture shift will have a trickle-down effect, and that awareness and action on disability inclusion will increase across the country.

Our government is taking real action to address the rights of persons with disabilities. The careful writing of Bill C-7 is a testament to that. Representatives of disability organizations and leading disability scholars participated in consultations across the country. Their input informed the reforms proposed in the bill.

We recognize that disability inclusion requires more than legislation. That is why we are continuing to work with the disability community and other stakeholders to address stigma and bias. It is important to bring about a culture change to ensure that the important contributions made to Canada by persons with disabilities are recognized and valued on the same basis as those of other Canadians. Going forward, we will continue to focus on improving the social and economic inclusion of persons with disabilities.

We will continue to work hard to ensure that all people are treated with the dignity and respect they deserve, especially when it comes to deep and personal issues like ending life. It is imperative that the voices of all Canadians, including Canadians with disabilities, continue to be heard on the issue of medical assistance in dying.

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

Mr. Speaker, my esteemed colleague mentioned the extensive two-week online public consultations that happened. I felt the questionnaire was extremely lean, so I held a town hall in my riding with more than 100 participants and we went through the online survey question by question.

It was clear that regular Canadians were being asked to make decisions on highly nuanced questions that were much more appropriate for health care professionals with clinical knowledge to answer. Many chose not to fill in their multiple choice options because of the biased slant of the questions. They chose instead to fill in the comments section to ensure their true answer was recorded without the ability for bias.

When will we have access to the 300,000 responses, most especially the written comments?

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, I thank the hon. member for the excellent question and the concerns that have been raised in the House. Again, we know this is an incredibly complex issue and an incredibly personal issue. Our priority was to listen to Canadians, which is why we conducted extensive consultations with doctors, nurses, the disability community and vulnerable populations across the country. We received over 300,000 responses to a survey that asked Canadians their opinion on MAID.

The legislation before us is of course a reflection of the Quebec Superior Court decision on Truchon, but we firmly believe that it is also a reflection of Canadian voices from coast to coast to coast through those extensive consultations. In terms of accessing the survey results, I do not have that information now but I am happy to provide that information to the hon. member outside of the House.

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

Mr. Speaker, one thing the NDP is concerned about with this legislation is that people with unendurable suffering face a 90-day period of assessment.

We are wondering where that number comes from. Who gave the Liberals that advice? It would seem that in this situation people seeking this treatment would very much appreciate a more rapid response.

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, that is an excellent question. If we read the preamble to Bill C-7, we will see the legislation's explicit desire to balance several interests and values: the autonomy of the person seeking a dignified death, the protection of vulnerable persons and the important public health issue that suicide represents.

I believe Bill C-7 achieves that balance by relaxing safeguards for Canadians who are at the end of life, but also strengthening safeguards and, just as important, strengthening supports for Canadians who have a grievous and irremediable medical condition and are in an advanced state of irreversible decline, but not necessarily at the end of life.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

Mr. Speaker, given the fact that the government, and he is a member of the government caucus, has chosen to accept the decision of a Quebec court rather than appealing it to the Supreme Court of Canada, I would guess the rationale would be based on a sense of urgency to deal with this issue.

I am wondering if I can count on my hon. friend across the way to make the same point in his caucus meeting about the decision in Alberta that the carbon tax is out of jurisdiction, and that the government will accept the Alberta court's decision as much as it is willing to accept the Quebec court's decision on this matter.

[Irek Kusmierczyk, Liberal, Windsor—Tecumseh, ON]

Mr. Speaker, I am not sure the question is cogent to this incredibly personal, complex and emotional discussion we are having in the House, but what I can say is that our government remains committed to protecting vulnerable individuals and to protecting the equality, value and self-worth of all Canadians.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Speaker, we have a unique opportunity to fix our assisted dying laws and to protect the individual right of all Canadians to make such a fundamental and deeply personal choice for themselves.

I opposed the assisted dying laws in the last Parliament because they were too restrictive. They were not in keeping with the Supreme Court's decision in Carter and I believed them to be unconstitutional, and here we are. A Quebec court found the law to be unconstitutional and we agreed, rightly, to abide by that decision. We have another chance to get it right.

As we look forward to what getting it right looks like, we should also look behind us at the Supreme Court's decision in Carter.

Those in the House have talked about striking a balance between the fundamental freedom of individuals to choose for themselves and the autonomy of the individual to make such a deeply personal choice, and protecting vulnerable persons.

For people who read the Supreme Court's decision in Carter, they will know that the Supreme Court struck that balance with a number of safeguards that look like this: to be eligible for assisted dying, one needs to be suffering intolerably and in an enduring way; one needs to be in a grievous and irremediable condition, an incurable illness; and the individual in question needs to be competent and to clearly consent.

The government in the last Parliament incorrectly, in my view, added an additional criterion for eligibility that one's death needed to be reasonably foreseeable. That is unnecessarily and unduly restrictive. I will get to a court case in particular that explains this in greater detail.

There are two core injustices that the new law proposes to fix. First, the question of removing the “reasonably foreseeable” requirement as a matter of eligibility, and also addressing the case of Audrey Parker.

We had another fundamental injustice where an individual who was eligible for MAID took her life earlier than she otherwise would have, lost time in her life that she otherwise would have spent with her family and loved ones. She was worried about losing competence and being unable to give consent near the very end, despite the fact that was exactly what she wanted.

The Council of Canadian Academies identified three levels of advance request: where an individual is already eligible for MAID, such as in the Audrey Parker case; where an individual has been diagnosed and is not yet eligible, but is on the path towards eligibility; and where someone has not yet been diagnosed, so is farther from eligibility for MAID. In this case we have identified a solution to one of those categories, but we ought to solve advance requests more broadly going forward.

Is the law perfect? No, but it is worthy of our support at second reading. However, there are a number of concerns worth highlighting.

First, while a reasonably foreseeable death is no longer a criterion of eligibility, there are additional hurdles for individuals to pass if their death is not within the near future. One of two practitioners assessing eligibility must have expertise in the condition. Although that sounds very reasonable in theory, my only question for committee members as they look at this is to ensure that is not an impossible barrier in practice, particularly for those in rural communities where such expertise may not exist at all times.

There is also a minimum, and I would say somewhat arbitrary, period of 90 days for the assessment of the request. It looks like a backdoor cooling-off period. It would make far more sense for us to have no time limit and the assessment to be done in the ordinary course, or at least a much shorter time period, because we are talking about people who are suffering incredibly and are competent to make the decision for themselves.

Does it cure the case for Audrey Parker? I think largely it does, but I worry if the main procedure must be scheduled already, what does that mean? If Audrey Parker was in a situation to say, “I am not exactly sure what the time period will be. I know it is not now but I know it will be soon”, is she to have scheduled a particular date, which would make her eligible for the advance request, or are we going to put people in a situation where they are scheduling something earlier than they otherwise would?

Mental health is a real challenge because we are building an additional criterion into this legislation that says:

For the purposes of MAID eligibility, a mental illness is not a “serious and incurable illness, disease or disability”...

It sounds reasonable on its face in many ways, because we can immediately imagine a situation where mental illness impinges upon one's ability to give consent, impinges upon one's ability to conduct himself or herself as a competent person, but that is not always the case.

I am aware of some opposition from the Conservative benches. I am also aware of the number of Conservative MPs who come from Alberta. Therefore, want to quote a case from the Alberta Court of Appeal from 2016.

This is about a 58-year old women, identified as E.F., with severe conversion and psychogenic movement disorders.

The court wrote:

She suffers from involuntary muscle spasms that radiate from her face through the sides and top of her head and into her shoulders, causing her severe and constant pain and migraines. Her eyelid muscles have spasmed shut...Her digestive system is ineffective... She has significant trouble sleeping and...is non-ambulatory...While her condition is diagnosed as a psychiatric one, her capacity and her cognitive ability to make informed decisions, including providing consent to terminating her life, are unimpaired.

This women was eligible to take advantage of MAID because we did not yet have an unconstitutional law in place to prevent her from accessing the regime. The Alberta Court of Appeal determined this woman was competent and was able to consent for herself. It noted further that she had consulted with her husband and adult children, who were all in support.

I worry that if we look at restricting mental illness completely, even if it does not impinge upon people's consent or their ability to conduct themselves as competent persons, we are telling those individuals that they are unable to make fundamental and deeply personal choices for themselves and that they have fewer rights than we do. That cannot possibly be right in this society.

This was a recurring problem for the justice department. When it argued the case of E.F. and lost at the Alberta Court of Appeal. it argued that the current criteria meant that terminal illness was required. The court said no. It argued that illness for a psychiatric condition should be deemed ineligible. Again, it lost in the Alberta Court of Appeal.

Therefore, if we are to respect the Carter decision and the precedent in case law since the Carter decision, I do not think we ought to have such a categorical exclusion in our law.

In Carter, the Supreme Court noted:

It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.

The Alberta Court of Appeal stated, “The cruelty in the situation is there regardless of whether the illness causing the suffering may be classified as terminal”, and certainly continues to be there regardless of whether the suffering has, as its primary focus, a psychiatric disorder.

As a final note on this subject, this law, if carried forward without an amendment, will treat mental illness as lesser than physical illness, a stigma we have worked hard to combat in other settings.

As I said previously, we have to tackle advance direct requests more seriously than we have in this legislation. I know there is an ability to have this broader conversation later this year, as we revisit this conversation. I certainly think if people are diagnosed with a condition and they can clearly see where it is heading, they should be able to determine their futures. I would want to, as a matter of my fundamental freedoms, be able to determine my future. Also, in directing our own futures, we ought to be able to provide advance requests more broadly and more easily, even if we have not been diagnosed.

I recognize the Council of Canadian Academies has identified that we need certainty. How do we provide certainty? Through sunset clauses. If we have not revisited and re-upped our commitment to our advance request within a certain period of time, then it would fall away. That would allow for certainty to take hold.

There are other things we could look to in the law, including mature minors, because minors have the ability to make life-changing decisions in medical contexts in other settings outside of MAID. However, in the end, this law needs to ensure that anyone eligible for MAID, pursuant to the Carter criteria, continues to be eligible for MAID through this law. It is a matter of fundamental freedoms and dignity in the end.

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

Madam Speaker, the Liberal government has sent a clear message to the provinces that euthanasia access is a priority over palliative care, as we can see from the fact that the Liberals are letting a Quebec lower court judge steer the way forward for the rest of Canada. We can also see, on the opposite side of the country, that the Fraser Health Authority in British Columbia leads the charge by revoking funding for hospice care beds and is confiscating private charitable donations for the implementation of MAID access.

Why is the government not fighting to ensure quality palliative care access before euthanasia?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, I trust the member heard me when I quoted not only the Supreme Court, which the Quebec Court was reiterating the Supreme Court's criteria, but also the Alberta Court of Appeal, which was again reiterating the Supreme Court's criteria.

The dichotomy between palliative care and death with dignity is so completely false. Of course a government ought to be focused on providing all the options for people at the end of their lives to ensure there is dignity. However, in the end, the government has no right to take away my fundamental individual choice.

[Charlie Angus, NDP, Timmins—James Bay, ON]

Madam Speaker, I listened with great interest to my hon. colleague, for whom I have a great deal of respect.

On the issue of the advance directive, when we think in advance, I think all the individuals I have ever known have talked about how they want to go and how they want to be. My friend was going to sit in the snow, listen to Bob Dylan and drink a bottle of whiskey on his last day. It is a great way to go, but we do not end up getting those options.

When we are faced with death, and I saw this with my sister and her horrific suffering, and her husband just before that, both very young, the will to live is so incredibly strong. People do not realize how much they want to live and how much they want to stay.

I know this is not so much the purview of the bill, but I want to ask about the reasonable limits of advance directives so we are not signing off and saying, “In future if it happens, this is how I want it to be”. When it happens, we are in a very different place and in a different world than we ever imagined we would be.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, this is by far the most complicated area. There are some easy cases, like the Audrey Parker case, where people are already eligible for MAID, they understand their condition and it is very clear an advance request ought to be in place. It is harder, but still fairly straightforward, when people are diagnosed with a disease and there is a short-term trajectory when they can see that they are going to deteriorate significantly.

It is much harder when a person is not diagnosed at all. I am 35. Would I put an advance request in right now? How could that be intelligible? How could we make sense of that? There are two things to say to that.

I mentioned sunset clauses. If we are requiring certainty, individuals would have to revisit their advance requests and uphold those requests. There has to be a window of time when it would then fall away and not be legally valid.

The other thing to note is that the Supreme Court's criteria are also pretty key here. I cannot just say an advance request for anything of which I am eligible to die. I still have to be in a condition that is an incurable illness and where there is grievous, intolerable and enduring suffering. These are incredibly important safeguards to keep in mind.

[Kyle Seeback, Conservative, Dufferin—Caledon, ON]

Madam Speaker, I appreciate the member's comments on this and many other matters. I raise an issue with his suggesting the false dichotomy between palliative care and this legislation. In fact, in the previous Parliament, the House passed legislation in the preamble, which very clearly said:

Whereas the Final Report stated that a request for physician-assisted death cannot be truly voluntary if the option of proper palliative care is not available to alleviate a person’s suffering;....

This is a critical issue. Access to palliative care is critically short in the country, so there is no false dichotomy. Why is the member's government not putting together a pan-Canadian strategy on palliative care and investing the money necessary so we have that?

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Madam Speaker, the member should know that we have invested billions of dollars through bilateral agreements with provinces and we have set a priority of home care, including palliative care. The member should know that health care, fundamentally, and the delivery of palliative are within the provincial jurisdiction. The member should also know that in the end, regardless of whether there is palliative care, this is a question of whether individuals have a right to make such a deeply personal choice for themselves. Does the member believe in liberty or not?

[Gérard Deltell, Conservative, Louis-Saint-Laurent, QC]

Madam Speaker, I will be sharing my time with my colleague from Coquitlam—Port Coquitlam.

I am very happy to be taking part in this debate, which is a departure from our usual political and often partisan work as elected officials.

This is the third time in my parliamentary career that I have been asked to debate and vote on the issue of medical assistance in dying. I was a member of Quebec's National Assembly for seven years, and I have served here in the House of Commons since 2015 with the support of my constituents.

I was elected to the national assembly in 2008. As a member of that assembly, I participated in the first debate we had in Quebec on this issue, the first time in a Canadian legislature, in 2010.

I also was a participant in the debate we had four years ago in the House of Commons, when, for first time, we addressed the issue. Therefore, in my parliamentary life, this is the third time I will participate and vote on this very touchy, personal and non-partisan issue.

That is why I would like to remind the House of certain cardinal rules that should guide our actions as parliamentarians in this debate, which we believe should be totally non-partisan. Things may get tense at times, but debate must remain respectful.

Respecting the free vote should be one of the cardinal rules of this debate. In my view, there is no right or wrong position in this debate. There are only positions that we are comfortable with as human beings. Whether we are for or against, there is no partisan politics behind it. There is only the personal opinion that we hold, share and analyze.

Consequently, it is important to keep a completely open mind and respect the fact that certain colleagues from our own party may not share our point of view, while colleagues from other parties may. That is fine. There is nothing wrong with that, really. Some positions we adopt, and some positions we cannot be comfortable with. That is all.

We must respect the debate. We must respect personal opinions. We must respect the fact that there is no place for partisanship in this debate and that positions are neither right nor wrong. There are positions that we can agree with and others that we cannot. We must respect that.

There are also certain elements that we must bear in mind before we dive into this. In our opinion, the bill has some shortcomings.

First, we must respect the freedom of conscience of physicians who are called on to provide MAID. If a physician feels that they cannot in good conscience provide MAID, they should be able to say so and not have to proceed. I have spoken to many people in the context of this debate, in which I have been participating for a very long time. Everyone I have spoken to has told me that physicians can show a certain openness in some circumstances, but change their minds in others. Physicians should never be forced to act against their conscience.

Furthermore, we should always bear in mind that MAID, by its very nature, is the last level of health care that can be offered. We must never forget that the role of palliative care is to ensure that those who are ill can live with dignity even in tragic circumstances. Therefore, we must respect physicians' conscience and focus on palliative care.

Taking our time is another cardinal rule that must be respected in this type of debate.

Let me remind members that the first time this issue was addressed in Quebec, it took six full years, three different governments and three different premiers. There was a huge debate about it, a strong and wise debate. Each and every position had been clearly established by those people who participated in the debate. There is no rush. We must take our time.

For some people, we are talking about assisted suicide. It is a very touchy issue. The worst-case scenario is to rush it. Quebec spent six full years, and we should follow this example. It obviously will not take six years this time, but the first step took six full years.

Let's agree that this debate cannot be rushed.

Why are we debating Bill C-7 today?

When the House of Commons adopted Bill C-14 in 2016, I was a member of the committee that studied it. We knew then that Canadians would challenge parts of it and that there would be court rulings. That is exactly what happened on September 11, 2019, when the Quebec Superior Court struck down the notion of “reasonably foreseeable natural death” in the bill that became An Act to amend the Criminal Code and to make related amendments to other Acts regarding medical assistance in dying.

I did not know this before I looked it up, but it is interesting to note that the current Minister of Justice, a man for whom I have tremendous respect and esteem owing to his experience as a lawyer and a McGill University professor, voted against Bill C-14. Now, as Minister of Justice, he is sponsoring this bill as the federal government's response to the Quebec Superior Court's ruling. The bill addresses some of the issues but sets others aside.

The first fundamental element of Bill C-7 is that it eliminates the 10-day waiting period that the current law requires as a buffer between the person's decision and the operation itself, to ensure that the second opinion provided for under the act is in fact obtained. The court deemed this provision invalid, and the minister decided to accept that opinion.

Let's also not forget that the current law, which was passed four years ago, requires the provisions to be reviewed in just a few months, starting in June 2020.

The government decided to take note of the Superior Court of Quebec ruling and act accordingly. That is its right. However, regardless of our views on the issue, we feel that this subject involves some truly fundamental questions and raises highly complex legal concerns. We think this ruling should have been appealed to the highest court in the land, so that the nine justices of the Supreme Court could study every possible ramification.

This bill sidesteps the issue of mental illness entirely. That is a very good thing, because in our view, it is extremely difficult to pinpoint the instant when a mental illness becomes irreversible, which can raise doubts about whether consent was given fully and freely.

As I said earlier, the worst thing we could do in this matter is move too fast. There is no rush. This concern may eventually be debated, but for now, let's take it one step at a time.

Since my time is almost up, I would just like to say that in this debate on such a delicate, sensitive issue, the worst thing we could do is plough full steam ahead and attack people's convictions instead of respecting their choices. Let's take the time to do things right on this extremely delicate and extremely important issue.