Debates of Feb. 23rd, 2021

Criminal Code

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

Mr. Speaker, in a 2017 position paper with respect to the previous bill on this issue, Bill C-14, the Canadian Mental Health Association said, “As a recovery-oriented organization, CMHA does not believe that mental illnesses are irremediable.” Again, “CMHA does not believe that mental illnesses are irremediable.” By adopting this amendment as proposed by the government, we would be directly contradicting what the Canadian Mental Health Association is saying with respect to mental illness. This is a government that talks about being guided by experts and science. That has become a totally meaningless talking point for it now. We have all of these organizations and the experts come forward to say that some people disagree. Come on. The evidence is very clear and the experts agree. Let us listen to the Canadian Mental Health Association and support the initiative of—

[The Deputy Speaker, Conservative, Bruce Stanton]

Time for one last short question in response. The hon. member for New Westminster—Burnaby.

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

Mr. Speaker, the issue raised by the member for Edmonton Strathcona was disability supports: a guaranteed livable basic income, a right to housing and universal pharmacare.

Would the member not agree that these are fundamentally important to improve the quality of life of Canadians with disabilities across the country?

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

Mr. Speaker, I will agree with the principle that we need to do more and do better to support individuals living with disabilities. There was a private member's bill from my colleague from Carleton, for example, to ensure access to work for people living with disabilities. I think we need to be thinking about the full spectrum of issues: access to work, access to housing, access to supports when people are not able to work and necessary supports, in any event.

To go into all of the depth required would be another debate, but I look forward to a time when we can have a discussion about how to do better to strengthen the living option, instead of these challenges always being used by the Liberal government as an excuse to ramp up the dying option. We should be talking more about how to facilitate assistance in living, as opposed to in dying. The priorities the government has when it is putting things before the House are so frustrating. In the middle of a public health crisis, the focus on trying to create an urgency around the death ramp, as opposed to the life ramp, is—

[The Deputy Speaker, Conservative, Bruce Stanton]

The time has expired, so we will now resume debate with the hon. Parliamentary Secretary to the Minister of Justice.

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

Mr. Speaker, I am very pleased to participate in the consideration of the amendments proposed by the Senate to Bill C-7, which seeks to amend the Criminal Code provisions on medical assistance in dying.

Our colleagues did a lot of work on Bill C-7 and proposed reasoned amendments following careful deliberations. The Standing Senate Committee on Legal and Constitutional Affairs heard from a variety of witnesses as part of two different studies. I followed the debate at second and third reading and thought that the speeches given in the Senate reflected the range of perspectives shared by the many witnesses.

It is therefore with great respect for the work of the Senate that we are examining the amendments it is proposing to Bill C-7. As the minister explained, there are three amendments that we plan to support, with some adjustments.

The first relates to the collection and analysis of data about the race of persons seeking MAID. Let me say here that we have heard extensively in the House of Commons and the Senate about the need for better and more robust data collection with respect to MAID. That data has been collected since MAID first entered into the legislative landscape, but certainly improvements can be made.

It is important now, especially during Black History Month, to note that one of the Senate amendments proposes tracking the analysis of data on the race of persons who are accessing MAID. This is important because we have clearly seen a light shone on the important issue of systemic racism in Canada, North America and around the planet. We need to understand how racialized persons, because of their inherent vulnerability, may be disproportionately impacted by MAID and address that vulnerability with our legislative response.

I would say, however, as articulated by previous speakers, including the minister, that the amendment the government proposes to make to this portion of what the Senate is suggesting would make it more inclusive in light of all of the witness testimony given in both the House and the Senate. By that I mean in addition to race-based data, data about disability and indigenous identity would be collected and analyzed. This, of course, is important, especially and specifically as we broaden the MAID regime to circumstances where death is not reasonably foreseeable, in response to the Truchon decision, which creates the real possibility that people will seek and obtain MAID because of vulnerabilities in their lives as opposed to their health conditions. I am grateful to the Senate for proposing this important legislative change.

The second Senate amendment the government supports, with some adjustments, is the sunset clause that attaches to the mental illness exclusion. We heard extensively about this from the previous speaker and in other interventions that have been made. The Senate amendment proposes a sunset clause of 18 months. The government is suggesting that the sunset clause be extended to 24 months.

Second, and very importantly, we are requiring that the Minister of Justice and the Minister of Health ask a group of experts to make recommendations on safeguards, protocols and guidance for MAID on the basis of mental illness alone. Those experts would be required to report back to the ministers within one year, which would leave an additional year for the government to consider what safeguards should be legislated and for Parliament to consider things when enacting any subsequent legislation.

I want to give some context surrounding the sunset clause because it is obviously a pressing matter for today's debate and a pressing issue for all parliamentarians.

The government's position is that it needs more time to consider and enact safeguards for the population of people whose sole underlying condition is a mental illness. The Minister of Justice was always clear that the questions of whether MAID for mental illness should be allowed and, if so, what safeguards were needed would be studied in the course of an upcoming parliamentary review.

What the sunset clause would do, in combination with a requirement for an expert review, is commit to a definite timeline for eligibility of persons whose only medical condition is mental illness. This would reduce the risk that some Canadians would feel the need to challenge the exclusion before the courts should they believe it is unconstitutional. It would also provide them with the certainty that two years following royal assent of Bill C-7, eligibility on the basis of mental illness would be considered with the requisite safeguards attached.

This point about potential constitutional challenges is not an academic point alone. We know this is a complicated issue that balances competing constitutional rights. Obviously we know from the Truchon decision that there has been litigation with respect to the old Bill C-14, and virtually all observers recognize that there is very likely to be constitutional challenges related to the current bill, Bill C-7, should it be enacted. In fact, we heard testimony about this at a House of Commons standing committee. Some witnesses said the exclusion of mental illness alone could perhaps give rise to a section 15 challenge. We are trying to ensure that Canadians who are concerned about this exclusion would have a remedy that is not via the court process, but rather through the task force of experts and the parliamentary study that would follow therefrom.

We heard a lot from the previous member about evidence and whether the government believes in evidence-based approaches. I would reiterate for the record that absolutely we do, and some of that evidence relates to a very specific document in the submissions that were made by the Association des médecins psychiatres du Québec.

In November 2020, the Quebec association of psychiatrists, or AMPQ, published a very informative discussion paper on access to medical assistance in dying for people with mental illness, which underscores the reasons that the government believes that a 24-month sunset clause is needed.

The work of this association will no doubt be foundational to the expert review of this issue. It points to some possible solutions, but they are fairly complex. That is why we need to carefully consider solutions that could work nationally.

The association is of the view that whether a mental illness is incurable or not can “only be determined at the end of a long process, after attempting several treatments and assessing their effects”. The association further notes that before coming to a conclusion on eligibility a psychiatrist “should explore other aspects that shape the patient’s life experience and consider strategies to improve the social circumstances that add to the suffering”. This dovetails exactly with some of the interventions made in the last portion of the debate by members of the NDP, who talked about supports that surround a person's life circumstances, such as income security, housing security and so on.

Going back to the submission from the association, it notes, “Psychiatrists must be involved as both the first and second assessors”, and also notes, “access to psychiatric care varies significantly from one region to the next.”

In light of all of these considerations, the Association des médecins psychiatres du Québec suggests that we create a new administrative body with regional offices dedicated to MAID on the basis of mental illness that would coordinate such requests, identify MAID assessors and providers, and ensure access to psychiatrists. It also suggest that such an administrative body could monitor the assessment process in real time instead of after the fact.

I highlight this in some detail because I believe the association's discussion paper is focal to why we as a government believe that a 24-month sunset clause is needed. The work of the association will no doubt be foundational to the expert review of this issue. The paper points to possible solutions, some of which are fairly complex in nature, which underscores the need for careful consideration of what could work nationally. Further, I underscore that government and Parliament will need time to make decisions about which safeguards should be codified in federal MAID legislation as a matter of criminal law relating to mandatory access across the country.

I will now turn to the third amendment.

The third amendment being proposed by the Senate, which the government proposes to support with some modifications, relates to the notion of the parliamentary review. The government has repeatedly committed to facilitating the start of the parliamentary review required by Bill C-14 as soon as possible following the adoption of the current Bill C-7. Our proposed adjustments to the amendment proposed by the Senate would ensure that all of the relevant issues are front and centre for the joint parliamentary committee that would undertake this work. I underscore the notion that it is joint, because it would be a combined study by the Senate and the House of Commons, similar to what we saw prior to the advent of the original Bill C-14. Its mandate would look at things that were contemplated by the original intended review of Bill C-14, such as requests by mature minors and issues that relate to advance directives.

In addition, we would include palliative care and safeguards for persons with disabilities within the scope of that mandatory joint parliamentary review by the Senate and the House. We also proposed to adjust the timelines, so they are both realistic in a pandemic environment but still ambitious, given the seriousness of the issues at hand. These are important features we feel would enable us to move forward in a collaborative manner involving the work of both Houses of Parliament, as well as the work of all legislators from various parties.

I would note parenthetically that, obviously, the member for Esquimalt—Saanich—Sooke has been very instrumental in leading the charge and a call for a study in Parliament of the previous bill, Bill C-14. Some of what we are proposing incorporates his views on the scope of what that review should look like.

Finally, there are two Senate amendments that, in the government's view, cannot be supported.

The first is the amendment to the mental illness exclusion itself. While I appreciate that some have advocated for greater clarity around what mental illness means in this context, the government is concerned that this particular amendment, as drafted by the Senate, implies that neurocognitive disorders are ordinarily understood as being mental illnesses, which, in fact, may not be the case. The federal government will work with its provincial and territorial counterparts to ensure a consistent application of the mental illness exclusion until it sunsets.

The second Senate amendment we propose to reject is the amendment to expand the waiver of final consent. Providing MAID in the absence of final consent is extraordinary and carries risks, and we acknowledge that. The Senate amendment goes beyond the scope and principle of Bill C-7, which would permit the waiver of final consent only in narrow circumstances that present the fewest risks. Any expansion of advance consent or proposal for advance requests, which are sometimes called advance directives, will involve greater risks and should be the object of careful consideration by the parliamentary review.

It has always been the notion that the issue of advance directives should be contemplated only after consideration by the broader parliamentary review. This was the case with the previous Bill C-14, and it is certainly the case now with what we are proposing as a government with respect to the parliamentary review that should ensue herefrom.

In the time I have remaining here, I would like to canvass a couple of points.

One is the notion that has arisen during the discourse of today's debate that somehow the government and de facto the Senate are somehow pursuing a route that is putting undue focus on facilitating an end of suffering, including facilitating the passing of an individual, as opposed to making the condition of life more viable and also more supported. That assertion is categorically false. The government's record over the last five and a half to six years speaks for itself in terms of the supports we have put in place, whether they are in long-term care, home care or supports for mental illness.

It relates to, as the previous member mentioned, a unanimous consent motion being passed regarding a suicide hotline. The supports we have put in place, such as the Canada health and social transfer, and a few intensive efforts to address home care and palliative care, are significant investments. We are ensuring that people are making such significant decisions based on the full understanding of what options are available to them and what supports are available to them. Can more be done? Of course, more can be done. I think that is what is important about what arises from a debate such as this.

The second thing I want to underscore is something that arose many times when Bill C-7 was in our chamber the first time, meaning its second and third readings prior to being sent to the Senate, which has again arisen today in the context of today's debate, and that is this idea that persons with disabilities are somehow being victimized, targeted or unfairly treated by this particular bill. I will raise a couple of important points, which I think are really important for all members of Parliament to understand. I have raised these points before, but I will reiterate them.

What we are talking about here is autonomy and the autonomy of individuals to make choices about the end of their lives and their passing, and that butts up against the need to protect vulnerable people. It is an important balance, and that is what is at the heart of this. This makes it probably the most difficult issue any of us have dealt with, at least it has been for me in my five and a half years as as parliamentarian. That being said, people need to understand that the case that was brought before the courts that we are responding to now was brought by two individuals: Monsieur Truchon and Madame Gladu.

Both suffered from disabilities, but because they were not near the end of their lives, they were prevented from accessing the MAID regime under Bill C-14. This is because it was, at that point and even now, until the law is potentially changed, an end-of-life only regime.

I want to read for members what the court analyzed with respect to that, because we have heard a lot in this discussion that somehow what we are trying to do in Bill C-7 is discriminatory of persons with disabilities. The notion of discrimination under section 15 was squarely in front of the court in the Truchon case, and what the court said is quite the opposite. I am quoting from paragraph 678 of the Truchon decision. The court said:

The requirement at issue reveals a legislative regime within which suffering takes a back seat to the temporal connection with death. Where natural death is not reasonably foreseeable, the consent in suffering of the disabled are worthy only of the sympathy of Parliament, which has adopted a protectionist policy toward every such person, regardless of his or her personal situation. As soon as death approaches, however, the state is prepared to recognize the right to autonomy. This is a flagrant contradiction of the fundamental principles concerning respect for the autonomy of competent people, and it is this unequal recognition of the right to autonomy and dignity that is discriminatory in this case.

The judge went on, in paragraph 681:

By seeking to counter only one of the stereotypes that the disabled face—vulnerability—the challenge provision perhaps perpetuates another probably more pernicious stereotype: the inability to consent fully to medical assistance in dying. Yet the evidence amply establishes that Mr. Truchon is fully capable of exercising fundamental choices concerning his life and his death. As a consequence, he is deprived of the exercise of these choices essential to his dignity as a human being, due to his personal characteristics that the challenged provision does not consider. He can neither commit suicide by a method of his choosing nor legally request this assistance.

I read this into the record to remind parliamentarians that discriminating against anyone in Canada should not be countenanced. However, what was squarely before the court was whether the old regime was discriminatory against persons with disabilities who want to make autonomous choices about their passing, but were not near the end of their lives. The court found, conclusively, that the old regime was discriminatory. That is what prompted this and other changes to the legislation.

I think it is very important to understand that. When I, and others, talk about the heterogeneity among people with disabilities, that is what we are driving at. It is not for Parliament, in my respectful view, to impede, limit or curtail the competence and autonomy of persons, including persons with disabilities, who want to make significant choices about how and in what manner to end their suffering.

I think a compassionate response by this Parliament, a response that entrenches dignity, requires us to do the opposite. I know it is difficult. I know it is moral. I know it is an issue fraught with a lot of personal conviction, and that it is a difficult task for many of us, but that is the task before us as parliamentarians. As somebody who is familiar with discrimination law, I wanted to correct the record, in terms of what I have heard in today's debate and previous debates, about how discrimination plays into the analysis.

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

Mr. Speaker, my colleague spoke about autonomy, and we have to listen to the disability rights organizations that speak about autonomy within a social context. When we talk about expanding autonomy, but we do so in a way that undermines the social context that people with disabilities will experience when they access the health care system, that is precisely what people are complaining about. It is just not good enough to say we have three or four litigants who think differently from the vast majority of the community. These are concerns the government should be taking seriously.

I want to ask a question specifically on the issue of the amendment from my colleague that we are talking about. The government's proposal for a 24-month sunset and an expert consultation predetermines the outcome, because it predetermines that the expert analysis will lead to a point of, in some sense, allowing MAID in cases where mental health is the primary complaint. We have seen how the government has failed to meet timelines before, as a result of prorogation, issues around the pandemic and other things that intervene. Why does the government not simply reject this amendment? Then, at some future point, it would be welcome to bring forward legislation after doing the required consultation, but not when they are—

[The Deputy Speaker, Conservative, Bruce Stanton]

Order. Quite a few people would like to ask questions.

The Parliamentary Secretary to the Minister of Justice and Attorney General of Canada.

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

Mr. Speaker, I thank the member opposite for his contributions today and in the past to this debate over the last many years.

The issue with respect to the social context and listening to disability rights organizations is one I concur with, and one I think our government would concur with. We cannot look at the perspectives and statements made by persons with disabilities without understanding the social context they are in, and the jurisprudence in the way the courts interpret discrimination bears that out.

I agree with him in that regard, but the point I made today and previously is that there is as much differentiation in the disability community as there is in many other communities, to echo the words of the member for Sherwood Park—Fort Saskatchewan, whether that relates to other marginalized groups, other vulnerable groups, etc.

With respect to the sunsetting and having a wide open study as opposed to a study that relates specifically to the mental illness condition, I have confidence in what we will hear from stakeholders. That is why I spent some time with the Quebec association of psychiatrists review. It provided extensive analysis about what it believes would be required should it be entertained, but it never presumed the end result of such a study. The medical establishment would—

[The Deputy Speaker, Conservative, Bruce Stanton]

I ask hon. members to keep their inventions to about one minute.

We will continue with questions and comments. The hon. member for Montcalm.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, the Conservatives talk about affirming human dignity. However, this affirmation is embodied in treating people as an end, never as a means. This is about affirming patients' capacity for self-determination and freedom of choice. Individuals are the sole masters of their own destinies.

The Conservatives are making sweeping generalizations and imputing motives by victimizing and targeting specific groups. Does the parliamentary secretary not think that our Conservative friends are violating respect for human dignity by exploiting the people they claim to be protecting?

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

Mr. Speaker, that is a very interesting observation and a criticism that I have heard many times.

Instead of addressing the question directly, I would like to begin by saying that I appreciated the member's work during our committee study.

I also want to emphasize that we need to listen to all members of the disability community, not just a few. That is what we are doing and that is what we will continue to do.

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

Mr. Speaker, in 2019 I brought forward a motion on a national suicide action plan. As an elected member, I went across the country, engaged with people and spoke to people. That is the democratic process. The Liberals voted for it and then did nothing.

I ask members to imagine a member of Parliament bringing forward a motion that if someone is depressed they can die immediately, that they can have the right to die. There would be debate and a national outcry. Instead, we have the Senate, the unelected and unaccountable Senate, put this motion in. With any dramatic change to any kind of law, the Liberals say that it is their friends in the Senate and that we should talk about this in two years.

This is not how these kinds of decisions are to be made. The fact that the unelected and unaccountable Senate could dramatically change legislation and cut a deal with the Liberals that it would be brought forward at a certain period of time, to me, is an insult to the democratic process. It is a greater insult when I hear the Liberals say that we should just get this bill passed, that we can worry about it down the road and that they trust what the committee will do.

To allow people who are feeling depressed to die is a major change to MAID. Liberals need to admit that and say it is well beyond the scope of this legislation.

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

Mr. Speaker, I thank the member for Timmins—James Bay for his contributions to the national suicide action plan. That is exactly the type of initiative we need more of.

I reject the insinuation, which seems to be repetitive of that of the member for Sherwood Park—Fort Saskatchewan, that somehow the Senate has been instrumentalized to do an end run around the House of Commons. Nothing could be further from the truth. The Senate has engaged in a study. It has engaged in a sober second thought.

The Senate has presented something to this House, and the accountability in a democracy such as ours is via the vote that will take place on these amendments. That is how we are held accountable to our electors, the voting populace in Canada, and that is exactly the purpose of today's debate and the forthcoming votes on the motions.

To insinuate something otherwise is entirely inappropriate and unparliamentary, in my respectful view.

[Raquel Dancho, Conservative, Kildonan—St. Paul, MB]

Mr. Speaker, I greatly appreciate the academic and legal vigour that my hon. colleague applies to his arguments.

My question is about my colleague's personal beliefs. He mentioned that the government will expand or extend the Senate amendment of 18 months on review for mental illness to 24 months and then provide another year to consider whatever an expert panel recommends. Therefore, within three years we may be debating mental health and whether people in the depths of a mental health crisis can access death. I would like to know if the member personally believes that it is ethical for Parliament to legislate access to death for people in the grip of depression.

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

Mr. Speaker, I know this is personal for others, just as it is personal for me. Obviously mental health touches all of us and all of our families, and it has touched my family.

That is a difficult question to answer, but what I would say is that I am comfortable trying to proceed incrementally as we have done, starting with Bill C-14 and now with Bill C-7, but doing it on the basis of having a lot of input from those in the medical community whose jobs are to diagnose, treat and provide support to those who are suffering from a mental illness.

What I cannot do, obviously, is put myself in the shoes of another person who, in terms of manifesting their autonomy, might be contemplating and considering taking such a step. That is difficult for me to do personally, but what I can do is ensure that I, as a parliamentarian, try to provide equal access to different options, including end-of-life options, to Canadians, should they choose to end their suffering.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I want to thank the hon. parliamentary secretary for a very helpful, thorough review of the government's views on what has now come to this place from the other place.

I also wanted to focus, as his last remarks did, on some of his personal beliefs around the situation and the context for people in the disability community, the context for people who are experiencing extreme depression. We have to put that context in economic terms. We know that people who are in the disability community are far more likely to fall below the poverty line than able-bodied Canadians. It is a really significant crisis.

We experienced in CERB the ability to send a cheque for $2,000 to people across the country. I want to ask the hon. member if it is not time to look at guaranteed livable income as part of the package of public health measures, because poverty is the single largest component of health. As a social determinant of health, poverty is the largest measure. I know it is slightly unrelated to the debate on Bill C-7, but can we not move to eradicate poverty?

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

Mr. Speaker, I thank the member for Saanich—Gulf Islands for her extensive contributions to Parliament, including in terms of this debate.

Absolutely, the CERB issue raised the notion of a guaranteed income or a universal basic income. That idea has not left the scene and remains something that needs to be actively considered. I would point to the all-party anti-poverty caucus as evidence that this idea has cross-party support. Its time has come as an idea, and I lament that a pilot project to gather evidence in Ontario was unfortunately eliminated midstream by the provincial Conservative premier in Ontario, despite having been started by a provincial Liberal premier in Ontario who preceded him. Developing that evidentiary base through some sort of pilot project makes eminent sense, from my perspective.

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

Mr. Speaker, it is 100% guaranteed that we will kill people who would have gotten better. That is a statement made by a well-respected Canadian psychiatrist this weekend at an emergency Bill C-7 meeting I cobbled together in response to this Frankenstein bill that we are now debating here in the House. How the Senate managed to change the bill from what it was to what it is completely boggles the mind.

The bill is now so deadly that not only are the disability community and the indigenous community crying out against it, but the mental health community and the geriatric professionals have joined in sounding alarm bells against the extreme danger this bill poses to the most marginalized in our communities.

Some in the Senate in the Liberals' group of wealthy, worried well people have decided that their wishes far outweigh any harm that may come to the vulnerable who cannot afford or cannot access the kind of care that powerful individuals can.

Let us take the issue of advance directives. Senator Pamela Wallin stated, “As someone with a history of dementia in my family, I seek the peace of mind that an advance request—and consent to it—will provide.” I would like to pose a question. Does Senator Wallin's peace of mind carry more weight than the premature deaths of frail seniors that will result if this amendment becomes law?

Imagine a person—for example, Senator Wallin—possibly dealing with dementia at some future time who has reached the stage at which her advance directive authorizes her death. Imagine that she is completely unaware of her cognizant deficits and is living happily with her loving family or in a top-notch residential setting somewhere in Canada. Who will give the MAID order? How will Ms. Wallin's caregivers explain this to her? Will that directive take precedence over her current wishes and those of everyone around her?

Imagine now a family that is less loving, one that is fighting over the inheritance while mother is still alive, fighting over how much is spent in paying for nursing care. This is a common scenario, as many professionals witness. Now who will give the MAID order, and in whose interest?

Now imagine there is no family and that the administration at the nursing home is under orders from the ministry to find beds for patients to be transferred from the hospital. There are already horror stories from around the world where advance directives for euthanasia exist as an option, stories of doctors trying to sedate their patients by putting sedatives in their coffee or stories like that of a 74-year old Alzheimer's patient from the Netherlands whose family had to hold her down as she was struggling so that the doctor could administer the lethal cocktail.

I learned in a conversation with Dr. Catherine Ferrier, who works with dementia patients, that often when a person is suffering with dementia, it is their family who are most distressed. Patients themselves are often content, even happy. The point I am trying to make here is that it is impossible to know the exact wishes of someone who is suffering with dementia. Someone who is young and healthy can imagine what they would want for themselves if they were to decline in that way, but they do not know what that future self, in a state of mind that they do not understand, would actually wish for.

I am terrified for vulnerable Canadians who want to live despite an earlier wish to die. They will not be able to communicate their desires, and their families and caregivers may pressure them to die to remove a burden from their own lives. I implore my colleagues to remember that our duty is to promote the safety and well-being of all Canadians, especially those most marginalized, not to calm the worried well.

The Council of Canadian Academies' expert panel working group on advance requests for MAID found that relatives of patients with dementia generally support euthanasia if an AED exists, but when they are faced with a decision to follow an AED, most decide against it. Many experts now favour, instead of a directive giving specific instructions, a process of reflection on broad health care goals, conversations with loved ones and the designation of a proxy decision-maker.

Listening to those who advocate MAID by advance request for patients with dementia, our first reaction should be horror at the demeaning and discriminatory terms in which they are depicted. To state that people who no longer recognize family members, are bedridden or are dependent for hygiene or feeding have lost their dignity is a marginalizing and ableist depiction. Dignity is never lost, but it can be either affirmed or denied.

Let us tackle the first myth, the myth that people deserve death with dignity and that MAID provides that. The fact is that this debate has distorted what dignity means. Dignity means to deserve honour or respect. What MAID advocates mean by “loss of dignity” is a loss of control, a loss of superficial appearance, a loss of self-critical judgment. They have tragically subverted the most dignified acts of all: unfailing love and deep respect for each other in all life circumstances. Bathing my dying grandmother, whispered conversations on the threshold of death, silent reflection and presence through a long night waiting for a last breath: These are the moments of greatest dignity. Dignity is found within our relationships. It is about whether someone looks at us and treats us with respect, rather than with subtle disdain or prejudice or by making us feel that we are bothering them.

Dignity is not about the means of death. Dying with dignity means dying in a milieu of care, love, kindness and respect. Anyone who says all these things are not present in a natural death setting simply does not understand what dignity is.

However, wait; the senators, the Liberals, Jocelyn Downie and all their friends at Dying with Dignity will cry, “No one will be euthanized under this legislation who has not already freely consented to it.”

The notion of consent by advance directive is not that simple. The vulnerability and power imbalance that is present between the parties is glaringly obvious. However, advertising campaigns and media have been busy creating a fantasy world for Canadians that pretends that the use of a physician in ending the life of someone not near death is compassionate and respects autonomy. We read in the paper about parties being organized to celebrate the last moments of life with balloons and symphony music playing in the background. We can see by the few statistics that are being reported that the glorification of euthanasia provides encouragement for those who are already unsure of their value or feel a burden to their loved ones, regardless of the fact that they are not near death.

In actual fact, what we are able to provide families with amounts to moral absolution. With this bill, we are offering to make legal what is illegal in every other country around the globe. Let me repeat that: There is no other country on the planet that allows death administered by a doctor to someone who is not imminently about to die if they have not first been given treatment. Canada, with the implementation of this legislation, will be the only country in the world where access to alternative treatments is not even required in order to qualify for death by physician.

Not only are the changes to the euthanasia regime that will come with the Senate amendments unprecedented from a legal and moral perspective, but they are also unheard of from a medical perspective. This bill would require doctors who work with patients suffering from mental illness to prescribe death, with no evidence, no data, no statistics to prove that it is an effective or beneficial treatment. There has been no due diligence done by the medical community to support the idea that MAID belongs in the tool box of mental health professionals. It is politicians, motivated by ideology and not by evidence, who have forced it upon them.

I have been told by doctors who support MAID in principle that this bill will force them to act against their conscience and their Hippocratic Oath. It is one thing to conscientiously object, but it is something much worse when there is a lack of faith in the treatment they are forced to provide. To make the concept more clear, they explained that doctors do not prescribe cigarettes to patients because the health risks far outweigh the calming benefits of nicotine. These same doctors know that there is no evidence to support the idea that MAID is an acceptable medical treatment for mental illness. Thus, if this bill passes, doctors will be forced to provide, against their conscience, an unproven treatment that causes the demise of their patient.

Further, allowing MAID for mental illness in this bill makes the bill incoherent. On the one hand, it says that MAID can only be offered to those who are not dying if their condition is grievous and irremediable. On the other, it fails to acknowledge what psychiatrists know to be true; that it is impossible to know if a mental illness is irremediable. There are many cases of doctors who have thought that a patient's condition was irremediable, only to find that the patient got better. This means that the entire entry point of accessing medical assistance in dying is not satisfied for those who suffer from mental illness. That is why doctors are pleading with us, telling us that they are 100% certain that if we accept this amendment, we will kill people who would have gotten better. This bill would ensure that people would no longer be seeking to avoid a painful death, but, rather, to escape from a painful life.

It is also important to tackle the second myth being propagated by the Liberals and their friends at Dying with Dignity, and that is the myth that Bill C-7 is not discriminatory. Here are the facts. Canadian disability organizations, mental health organizations, indigenous organizations and the United Nations all say that Bill C-7 is absolutely discriminatory. The bill singles out vulnerable Canadians and offers them physician-assisted death without offering adequate disability supports or treatment to help them live full lives, free of the suffering caused by poor health care, poverty and stigma. It singles out persons with disabilities who are not terminally ill as fit for suicide completion. This will become a choice of desperation, not autonomy.

Let us understand what discrimination really is. It is pretending that all Canadians are equal in all ways. The obvious reality is that some of us face profound life challenges. We need laws that protect the disadvantaged. A law that offers death to one group and support and treatment to all others is the paradigm of discrimination. This law proclaims that a disabled Canadian or someone suffering with a mental health challenge should consider death instead of recovery. Vulnerable patients need protection from politicians and doctors who want to make it easier for them to die, while simultaneously denying access to appropriate health care supports. This is true discrimination.

Let us face it, there is a myriad of reasons that many organizations have come out opposing the bill.

Take as another example the testimony from Tyler White, CEO of Siksika Health Services, who stated:

MAID with its administration of a lethal substance with the intent to end a person's life is countercultural to our indigenous culture and practices. Our concept of health and wellness does not include the intentional ending of one's life. We recognize the dignity [of life] from its beginning to natural death, and efforts to suggest to our people that MAID is an appropriate end to life is a form of neo-colonialism. Extraordinary efforts have been made in suicide prevention in our communities and the expansion of MAID sends a contradictory message to our peoples that some individuals should receive suicide prevention, while others suicide assistance....

...Bill C-7 in its current form is the absence of protection for individuals working in our communities who do not wish to participate in MAID. We believe that our people should not be coerced to participate in non-indigenous practices against our conscience and will. And it is the kind of oppression that has been the source of much trauma in our history. The Truth and Reconciliation Commission of Canada calls upon those who can effect change within the Canadian health care system to recognize the value of aboriginal healing practices and for respecting indigenous people's right to self-determination in spiritual matters, including the right to practise our own traditions and customs. Bill C-7 should be amended such that those who opt to abstain from participating in MAID directly and indirectly will be protected to do so without discrimination in their employment in the health care system.

How about Margaret Eaton, national CEO of the Canadian Mental Health Association, who stated the following in a recent press release:

Anyone living with mental illness knows it can absolutely be grievous and...unbearable. However, what sets mental illness apart from all other types of suffering is that there always remains the hope of recovery. That’s why the Senate’s amendment to C-7, the assisted dying bill, is so concerning.

People with a mental health problem or illness need assistance to live and thrive, not hasten death.

The Canadian Mental Health Association...is urging MPs to vote against the amendments made by the Senate to C-7. In particular, the clause to start the clock on eventually allowing people to seek medical assistance in dying...with mental illness as a sole underlying cause.

Then there is the petition I received this morning from 130 psychiatrists, psychotherapists and mental health professionals, calling on us to reject the amendment which would include mental illness as a sole criterion for medical assistance in dying. It states:

Some persons with mental illness, that often includes symptoms of hopelessness and suicidal thinking, have long been recognized as potentially vulnerable to suicide inducement and, until now, have rightfully been excluded from eligibility for MAiD. Suicide prevention is recognized as a critical mental health service necessary to preserve life. Review of evidence...found that, unlike with MAiD for terminal illness, we cannot distinguish between those seeking MAiD for mental illness and suicidal individuals.

Over and over again, we have heard from medical professionals how disastrous the bill will be to the safety and security of their patients.

Therefore, the question begging to be asked is this. Why the rush? During the pandemic, the Liberals have made the passage of Bill C-7 their priority. However, the bill is not a high priority for Canadian citizens and it is safe to assume that the majority of Canadians know very little about Bill C-7 or its implications.

Canadians have been preoccupied with more pressing matters, such as keeping themselves and their loved ones alive during this pandemic. They have been concerned with keeping financially afloat, making rent and mortgage payments, keeping their jobs and keeping their businesses from going under.

However, throughout this time, the Liberals have been concerned with driving Bill C-7 to the post, perhaps with the hope of slipping one by a distracted public. This is one of the most serious changes of legislation in law undertaken in a long time, with far-reaching implications. It will surely change the character of the country and how life and death is viewed. It has, at the very least, the potential to cause individual and social harm and open up abuses that no safeguards can guarantee against.

I will end with one final quote from the Washington Post this week under the title “Canada is plunging toward a human rights disaster for disabled people”. It said:

This month, the Journal of Medicine & Philosophy found that in the 18 years since Belgium permitted this sort of euthanasia, the laws and regulations meant to protect patients from abuse “often fail to operate as such.” Much like in the Netherlands, the eligibility criteria had steadily expanded to the point where more and more people pursued it not for medical reasons but simply for “tiredness of life.”

Legalizing assisted death for disabled people only fortifies the underlying problem: Canada has long mistreated its disabled citizens. This bill is a workaround for that problem, not a solution.

I ask this one more time. If this bill is so good, why are the vulnerable, the poor, the disabled, our indigenous brothers and sisters feeling so threatened? Why do we want our hospitals to offer suicide prevention programs through one door and doctor-assisted suicide through the other? I beg my colleagues to hear the cries of those most vulnerable among us and reject the discriminatory and dangerous bill, Bill C-7.

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Mr. Speaker, I listened with great interest to this member's intervention, particularly when she talked about at the end of life and the dignity that one should have. She talked about those sweet moments of somebody laying on their bed just before passing away swiftly into the beyond death, as though it could only ever be this incredible experience for family and friends to sit around and to take great solitude in the dignity of what was happening.

Let me paint another scenario. The end of November of last year, my father-in-law had an operation for tumour on his brain. After coming out of that operation, the doctor said, “I am sorry Don, there's nothing we can do for you. Unfortunately, you're going to die.” Don spent about seven to nine days in the hospital, with his wife at his side, often having seizures and going through some very intense pain before he finally passed away. He did not have that opportunity of which she spoke. Where was his dignity?

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

Mr. Speaker, the death of a parent is a very difficult thing. That is why we have been calling for better palliative care. Things can be peaceful and different.

My father-in-law passed away also. We as family were able to be around him and sing psalms from the Bible. It was a wonderful time in our lives where we could reconnect and remember the history my father-in-law passed down to us and our grandkids. Palliative care must be our first goal. We must ensure that all Canadians can access it. Right now only 30% of Canadians can access good quality palliative care. I ask the member to please support that.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Mr. Speaker, I have a question for the hon. member.

With all due respect, I take exception to her comments.

She provided a definition for dignity and the word “respect” stood out to me. Dignity is also humanism.

As a parliamentarian, does the hon. member not think that refusing to pass the bill, amended or not, is disrespectful of the will of a majority of the public who went before the courts to ask to make this choice with regard to their life?

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

Mr. Speaker, what is really shameful is that we did not ask for this lower court decision to go to the Supreme Court. One lower court judge from Quebec should not decide a complete change in the way Canadian law works and the way our mental health and disabled patients are treated. Again, I beg that we have a fulsome discussion and go all the way to the Supreme Court with this.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Mr. Speaker, I want to make remarks on the use of the very ableist and possessive language my colleague used when speaking about “our” indigenous and disabled people. I want to remind her that we are sovereign, independent individuals capable of making our own decisions and owned by nobody.

In her arguments, the member used the term “self-determination”. I agree that indigenous and disabled people have a right to self-determination as referred to in the UN charter of human rights. I wonder if she applies the same right to self-determination, particularly for indigenous people, when she refers to resource extraction projects, which include things like pipelines, mining, any sort of resource extraction. Does she provide them the same level of respect for self-determination?

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

Mr. Speaker, I would point out that I was reading a quote by Tyler White, the CEO of Siksika Health Services. Therefore, everything I said when I used that terminology were not my words; I was simply reading from what Tyler White said.

It is inappropriate, at a time when we are discussing such a massive change to our health regime and euthanasia, to talk about pipelines.