Debates of March 28th, 2022

Royal Recommendation for Bill C‑237

[Alain Therrien, Bloc, La Prairie, QC]

Mr. Speaker, on Monday, February 28, the Chair encouraged members who would like to make arguments regarding the requirement for a royal recommendation with respect to Bill C‑237 to do so as soon as possible. I would like to make some arguments. I will be brief.

Bill C‑237 amends the Federal-Provincial Fiscal Arrangements Act to provide that a province may withdraw from a federal program in an area under the legislative authority of the province if, and only if, the province itself has a program whose objectives are comparable to those of the federal program. The province that withdraws is to be paid the same amount of money it would have received had it participated in the federal program.

By the same token, it amends the Canada Health Act, but only for Quebec. I will not reiterate the arguments that the bill's sponsor, the member for Bécancour—Nicolet—Saurel, so eloquently laid before us on March 1, but I fully agree with everything he said. Like him, I feel that Bill C‑237 does not require a royal recommendation because it does not change the amounts transferred to the provinces, how funds are divided among the provinces, the end use of the funds or the executive's power to determine whether a province has a comparable program that justifies withdrawing from the program.

I would like to add a few points for the Chair to consider.

Section 54 of the Constitution Act, 1867, grants the power of initiative in tax matters to the Crown as follows:

It shall not be lawful for the House of Commons to adopt or pass any Vote, Resolution, Address, or Bill for the Appropriation of any Part of the Public Revenue, or of any Tax or Impost, to any Purpose that has not been first recommended to that House by Message of the Governor General

It clearly states “any purpose”. The same term is used in Standing Order 79.

Over the years, the Chair has had occasion to clarify the scope of that term. According to page 838 of House of Commons Procedure and Practice, third edition, the Chair has ruled that in order for a private member's bill to proceed without a royal recommendation, its objects, purposes, conditions and qualifications must not be significantly altered.

My colleague from Bécancour—Nicolet—Saurel introduced a series of bills comparable in scope to Bill C‑237 that did not have royal recommendation.

On March 22, the Parliamentary Secretary to the Leader of the Government in the House of Commons presented two cases where the Chair had ruled that the bills required royal recommendation. These two bills have something in common. In both cases, the change in the conditions and qualifications opened the door to potentially increasing the amount of spending. In the case of Bill C‑490 introduced in 2007, it is clear. In addition to increasing the guaranteed income supplement, the bill set out that a person could retroactively receive the benefits for all the previous years they were entitled to receive them but did not apply for them.

The change in conditions and qualifications significantly increased the amount of spending. The Chair was absolutely right in that case to require royal recommendation.

The government also brought up the example of Bill C‑243, introduced in 2016, which was similar. It provided for a pregnant woman to obtain employment insurance maternity benefits before giving birth if her work posed a risk to her health or her pregnancy. It is true that the weekly benefit would not change. It is also true that the maximum number of weeks of benefits would not change either, but a third of new mothers do not draw the maximum number of weeks because they return to work before using them all.

We can assume that a significant number of women would draw maternity benefits for longer if they started to receive them a month, two months, or even three months sooner. Thus, the changes to the employment insurance eligibility conditions that were set out in Bill C‑243 had the potential effect of increasing the amount of spending.

Therefore, it was logical that a royal recommendation be required for that bill.

That is not the case with Bill C‑237. There is no possibility whatsoever that the bill will result in new spending or that its purpose will change. The government is suggesting a very broad interpretation of the royal recommendation. It is suggesting that when a bill with financial implications changes a condition or a qualification, it must be accompanied by a royal recommendation.

If that were the case, a bill to change the colour of a form would also require a royal recommendation because it would change the condition for access to a program, even though it would not change the amount or the purpose, which are the terms used in the Constitution or the Standing Orders. That is definitely not the spirit of the Standing Orders, as in future it would not be possible to make any amendements whatsoever to any budget bill.

In closing, in the Chair's interpretation of what constitutes a significant change when a bill amends the conditions and qualifications associated with spending, I suggest that we look to the terms used in both the Constitution and the Standing Orders. Does it change the amount of the expenditure? Does it change the purpose of the expenditure? If it does not change one or the other, it should not require a royal recommendation. In that sense, I believe that we should be able to vote on Bill C‑237 at all stages, even if the Crown were to refuse to grant a royal recommendation.

[The Deputy Speaker, Conservative, Chris d'Entremont]

I thank the hon. member for his intervention, which the Chair will take into account before making its decision.

It being 11:08 a.m., the House will now proceed to the consideration of Private Members' Business as listed on today's Order Paper.

Protection of Freedom of Conscience Act

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

moved that Bill C-230, An Act to amend the Criminal Code (intimidation of health care professionals), be read the second time and referred to a committee.

Mr. Speaker, it is a privilege to rise today to begin the debate on my private member's bill, Bill C-230, the protection of freedom of conscience act. This bill revives my private member's bill, which died on the Order Paper, from the last Parliament, with some slight modifications.

I would be remiss if I did not once again acknowledge that this bill is built on the hard work and determination of former members of Parliament. The first bill proposed to address this issue was introduced by the late Mark Warawa in 2016. His bill did not proceed because of the government's introduction of Bill C-14. After Bill C-14 was passed into law, my former colleague David Anderson introduced his private member's bill, Bill C-418, during the 42nd Parliament. However, that bill also died on the Order Paper when the general election was called in 2019.

I would like to thank all those who have been championing this issue for many years and their willingness to work with me. Experts throughout Canada have provided information and advice, while thousands of grassroots Canadians voiced their support for protecting our fundamental freedoms. I would also like to thank the Library of Parliament for its timely, diligent and expert research, which helped inform this proposed legislation.

For the purposes of this debate, I think it is important to understand conscience. There are numerous definitions of conscience, but they are consistent in defining it as an individual’s inner sense of knowing the difference between what is right and wrong and allowing that knowledge to guide their behaviour. The Canadian Charter of Rights and Freedoms, under the heading of “Fundamental Freedoms”, in subsection 2(a) states that everyone has the fundamental freedom of conscience. In this way, Bill C-230 is straightforward. It seeks to add two new offences to the Criminal Code of Canada. I will read the summary so members will know what they are:

This enactment amends the Criminal Code to make it an offence to intimidate a medical practitioner, nurse practitioner, pharmacist or other health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of medical assistance in dying.

It also makes it an offence to dismiss from employment or to refuse to employ a medical practitioner, nurse practitioner, pharmacist or other health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

This bill is a response to calls from disability rights groups, first nations, the Ontario Medical Association, legal experts and many medical and mental health professionals to protect conscience rights. It ensures that medical professionals who choose not to take part in or refer a patient for assisted suicide or medical assistance in dying will never be forced or coerced to violate their freedoms as stated in the charter.

Previous Parliaments have passed laws that created the unintended consequence of doctors and medical professionals being forced to participate in providing a patient's death, regardless of whether they believe it is in their best interest. Bill C-14 and Bill C-7 created a federal standard for medical assistance in dying and assisted suicide but not for conscience protections.

By way of background, sections 241.1 to 241.4 of the Criminal Code of Canada deal with the provision of medical assistance in dying. These sections are in part VIII of the code. It deals with offences against the person and reputation, which include offences such as homicide, kidnapping, assault and many more. Subsection 241(1) of the Criminal Code still makes it a criminal offence to counsel or aid in a suicide. It reads:

Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not,

(a) counsels a person to die by suicide or abets a person in dying by suicide; or

(b) aids a person to die by suicide.

When creating the exemption allowing for MAID, the government had to create an exemption to this prohibition on counselling or aiding in suicide. This then leads to the untenable claim that the Criminal Code already protects the conscience rights of medical professionals.

Some claim that the clarification clause, section 241.2 (9) of the Criminal Code, somehow protects conscience rights. It states:

For greater certainty, nothing in this section compels an individual to provide or assist in providing medical assistance in dying.

While I understand why some would want to think it protects conscience rights, I believe they are sadly mistaken. While I appreciate and support this inclusion in the Criminal Code, it only addresses one side of the coin. This clause only confirms that the Criminal Code is not the source of compulsion to participate in medical assistance in dying.

For the Criminal Code to have any teeth on this issue, it should articulate that it is an offence to compel someone to provide, or assist in providing, medical assistance in dying against their will. Compelling someone to participate in MAID can and does happen, which is why I have brought forward this legislation and why it needs to pass.

Regarding jurisdictional questions about this bill, as I mentioned earlier, this bill proposes that two new offences be added to the Criminal Code of Canada to address intimidation, dismissal from employment or refusal to employ a medical professional. This is similar to section 425 of the Criminal Code, which addresses the same actions taken by an employer to compel employees with respect to belonging to or organizing a union. I would suggest that if it is appropriate to have section 425 in the Criminal Code, it is reasonable to include the amendments I am proposing.

I would also submit that it is inaccurate to argue that conscience rights legislation somehow interferes with the role of the provinces while, at the same time, believing that the legalization of medical assistance in dying does not. Ensuring that conscience rights are protected is the responsibility of Parliament and of the Government of Canada, which is why I introduced this bill and why it should be passed.

Additionally, provinces can introduce their own conscience rights legislation for medical professionals. For example, Manitoba has passed simple and clear legislation in this regard, and I would encourage all provincial legislatures and parliaments to follow Manitoba’s example.

While the text of this bill focuses on the conscience rights of medical professionals, this legislation also serves to protect the right of patients to receive a second opinion. What do I mean by this? If all doctors are forced to propose MAID as a treatment option to their patients, this one-size-fits-all approach would give Canadian patients less choice, not more.

Additionally, individuals who object to MAID would be deterred from entering the medical profession altogether. Patients would no longer be able to seek a second opinion for their end-of-life care. In this way, conscience rights for medical professionals not only protect medical professionals and their patients, but they also protect our health care system.

Without conscience rights, doctors are constrained to provide, or refer their patients to receive, medical assistance in dying, regardless of whether it is their professional opinion that it is in the best interest of the patient. This concern for the patient’s best interest does not mean that a medical professional objects to medical assistance in dying in all cases, just that in his or her opinion it is not an option that should have to be offered in every case. This became especially pertinent to the medical community with the passage of Bill C-7.

To highlight the impact of the removal of the safeguard that death be reasonably foreseeable, I would like to quote from a recent column published online in Policy Options magazine which states the following:

Many injuries and physical illnesses are indeed accompanied by temporary depression and suicidal thinking. For example, research demonstrates increased risk of suicide for two years after a spinal cord injury. This suicidality overwhelmingly ends with adaptation and recovery support. Offering death to anyone during a period of transient increased suicidality is, in our view, unethical and violates the standard of medical care by which physicians must abide.

The fact that the newly expanded law may facilitate death in those circumstances of increased suicidal thinking is, in and of itself, problematic.

Some have tried to frame conscience rights as the rights of the patient versus the rights of the doctor. Nothing could be further from the truth.

Health care is fundamentally about the doctor-patient relationship. For example, take the psychiatrist who supports MAID in certain circumstances, but in a certain case has spent 15 years counselling a patient who suffers from bouts of depression and suicidality. For 15 years, they have built understanding and trust. What would happen if that patient, suffering from a bout of suicidality, should demand assisted suicide? Under current law, that psychiatrist would be forced to refer that patient to someone else so he or she could die. They must do this, despite knowing that the suicidal thoughts are temporary and that otherwise the patient is joyful and loves his or her life. Ending that patient's life would be wrong, but the psychiatrist’s hands are tied. This should not be what passes for medical care in Canada.

Some might claim that there are safeguards in place to prevent such tragedies, but I would ask them if they are absolutely sure. With the passage of Bill C-7, many safeguards for medical professionals were removed. We are talking about ending a human life. There is no room for uncertainty when a life hangs in the balance.

Additionally, should the first line of safeguards not be the expertise of the medical professionals who know their patients best? If those medical professionals do not believe death is the answer, should we not at least consider if they are right? However, this then leads to the concern some raise that protecting the conscience rights of medical professionals will block access to those who truly want it. I would suggest this is both misleading and nothing but baseless fearmongering. Medical assistance in dying and assisted suicide are readily available throughout all of Canada. There are information phone lines, hospitals staffed with willing medical professionals, even email addresses to help set up appointments. In a word, MAID has become the status quo. It is available.

The Canadian Medical Association also stated clearly that conscience protections would not affect access because there were more than enough physicians willing to offer MAID. Therefore, common sense should tell us that the charter rights of medical professionals are breached when they are forced to either offer or refer assisted suicide or medical assistance in dying. Surely, we have the capacity to both ensure access to MAID while still protecting the fundamental charter right to freedom of conscience.

Finally, some have suggested that medical professionals should leave their morality at the door. I do not believe we want this to happen. For example, we would all want and expect doctors to be bound by their morals if they were offered a bribe to move someone up on a waiting list. If we hold our medical professionals to a higher standard, we cannot then tell them to ignore their personal moral standards. Further, while discussing the issue of conscience rights with a doctor, she told me that, in the absence of conscience protection, the group with the most to lose are the patients, and they are the ones we are trying to help. This bill protects the doctor-patient relationship by ensuring that doctors and other medical professionals are always able to recommend and provide the care they believe is best for their patients. Patients need this bill to pass. Canada’s medical professionals need this bill to pass.

Over the past two years, we have seen just how important our health care system is and how critical the medical professionals who work in that system are to Canadians and our way of life. We need to create a work environment for medical professionals that protects them, supports them, and encourages them to continue in the critical work they do.

In closing, I encourage all members to support passage of the protection of freedom of conscience act.

[Chris Bittle, Liberal, Parliamentary Secretary to the Minister of Canadian Heritage]

Madam Speaker, leaving aside that this bill is likely within provincial jurisdictions regulating medical professionals, or professionals in general, and leaving aside it makes medical assistance in dying more difficult to access, I guess my question is in regards to other professions.

As a lawyer, and there was another lawyer sitting behind the hon. member, I was required to provide referrals to any client who came before me who I had a conflict with, or who I did not want to deal with. Law, like the medical profession, is a highly regulated profession. Why should doctors have that advantage over other professions when their patents' rights to access medical assistance in dying are at stake?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, I reject the premise that Canadians' access to MAID is at stake.

I just made the case that there is access to MAID in many circumstances in every province. I am a strong believer in the distinct jurisdictions of the federal and provincial government in Canada. That is why the bill that I have introduced respects the role of the provinces in the provision of health care and does not interfere with that in any way.

As I noted in my speech, the bill amends the Criminal Code, which falls under the jurisdiction of the federal government. I would encourage all provincial legislatures and Parliament to consider enacting protection for freedom of conscience acts.

[Claude DeBellefeuille, Bloc, Salaberry—Suroît, QC]

Madam Speaker, I am not convinced by the argument about the basic premise of this bill.

For example, in Quebec, we have a law that protects freedom of conscience for all professionals. Anyone who is a member of a professional association in Quebec has the opportunity to exercise their freedom of conscience and require it be respected.

I am a social worker and a member of the professional association of social workers. I have been a support person for people who chose to receive medical assistance in dying. I can assure the member that, in Quebec, any professional who does not feel comfortable supporting a person who made this choice can easily refuse to do so. The same thing applies to doctors.

Can my colleague explain to me what more this bill, which in my opinion infringes on Quebec's jurisdiction, does for people who want to die with dignity in Quebec?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, one of the most common threads we heard throughout the testimony from experts on Bill C-7 was that there was a need for national conscience rights.

The committee heard from patients rights groups, lawyers, disabilities rights experts, medical ethicists, indigenous leaders, imams, rabbis and priests, as well as individuals who provided testimony of their own personal experiences, which are very different than the one that the member spoke to.

I have also received emails from physicians from across the country who are deeply concerned about their ability to continue practising as a result of, and from those who have experienced, intimidation and coercion to participate in the provision of MAID.

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

Madam Speaker, I want to ask the member about the Ontario Court of Appeal ruling of May 2019, in the case of the Christian Medical and Dental Society of Canada versus College of Physicians and Surgeons of Ontario.

In this case, the court very clearly said that the obligation to provide a referral to procedures physicians might personally object to, including abortion, gender reassignment surgery and medical assistance in dying, was found constitutional because patients have a right to access information and to access health care services.

When the courts have decided quite clearly that the referral is not a matter of conscience, why is the member proceeding with this bill?

[Kelly Block, Conservative, Carlton Trail—Eagle Creek, SK]

Madam Speaker, obviously support for legislated conscience rights protection varies between associations and colleges, as well as from province to province.

I would just point out that paragraph 42 found that there was no direct evidence that access to health care was a problem caused by physicians' religious objections to providing MAID.

[Gary Anandasangaree, Liberal, Parliamentary Secretary to the Minister of Justice and Attorney General of Canada]

Madam Speaker, I am very pleased to speak this morning with respect to Bill C-230, an act to amend the Criminal Code, intimidation of health care professionals, which was introduced by the member for Carlton Trail—Eagle Creek. I want to acknowledge that I am speaking today on the traditional unceded lands of the Algonquin people.

The stated goal of Bill C-230 is to protect an important right: the right to freedom of conscience and religion, which is guaranteed by section 2 of the Canadian Charter of Rights and Freedoms. It is a laudable goal, but one that I do not think the bill achieves. The bill proposes to create two new criminal offences that seek to protect the right of health care professionals, including medical practitioners, nurse practitioners and pharmacists, to object to taking part in the provision of medical assistance in dying to provide services according to their conscience.

First, it proposes the creation of a new intimidation offence that would prohibit the use of coercion or any intimidating behaviour to compel a health care professional to participate, directly or indirectly, in the provision of MAID. Second, it proposes the creation of an employment sanctions offence that would prohibit employers from refusing to employ, or to dismiss, health care professionals solely because they refused to participate directly or indirectly in the provision of MAID.

We certainly all agree that it is imperative that the right to freedom of conscience and religion be protected, not only for health professionals in the context of medical assistance in dying, but for everyone in Canada.

This is central to ensuring that we are able to live our lives, both personally and professionally, with equal rights and dignity. However, I do not believe that the proposed Criminal Code amendments are necessary to protect this central right, so I must oppose the bill.

The proposed intimidation offence, which would prohibit the use of coercion or intimidation to compel a health care professional to participate in MAID, largely duplicates existing Criminal Code offences. For instance, in section 423, the Criminal Code already prohibits the use of violence, threats of violence, intimidation or attempts at intimidation to compel any person to abstain from doing anything that they have a lawful right to do, or to do anything that they have a lawful right to abstain from doing. Criminal Code section 346 also makes it an offence to extort someone, which is to use threats, accusations, menaces or violence to induce, or attempt to induce, that person to do anything or to cause anything to be done. These are both indictable offences and are punishable by maximums of 14 years imprisonment and life imprisonment, respectively.

The existing offences of intimidation and extortion apply in all circumstances, including in the context of the provision of MAID by health care professionals. I believe that these offences provide sufficient protection for health care professionals who do not wish to participate in the provision of MAID.

The proposed employment sanctions offence would prohibit employers from refusing to employ, or to dismiss, health care professionals simply because they refuse to participate in the provision of MAID. This is a valid and important objective, but I urge us to reflect on how such a provision may encroach on provincial and territorial jurisdiction.

As all members of the House are aware, MAID falls under the shared jurisdiction of the federal government, which has jurisdiction over criminal law, and of provincial governments, which are responsible for the provision of health care. However, with the exception of federally regulated sectors, employment-related matters generally fall within the responsibility of the provinces and territories. As such, employment concerns may be more appropriately addressed by the regulation of employers at the provincial and territorial level. Irrespective of jurisdictional issues, I also wonder whether criminal law is the right tool to use to address employment issues.

I am also mindful that, even though the preamble of Bill C-230 suggests that it seeks to respond to circumstances in which practitioners are required to make effective referrals for MAID, the bill would not address that issue because the professional orders that establish those policies would not be captured by the proposed employment sanctions offence.

We must remember that the MAID legislation simply permits the provision of MAID. It does not compel anyone to provide it, whether directly or indirectly. In fact, it contains a provision explicitly clarifying that “nothing in this section compels an individual to provide or assist in providing medical assistance in dying.” This can be found in subsection 241.2(9).

I am not aware of any evidence that suggests that health care professionals are being coerced or intimidated to provide MAID. I wholeheartedly believe that the criminal law already offers protection to anyone who may be coerced to participate in MAID. I would also like to remind members that the criminal law should be used sparingly.

I would also like to note that the proposed offences would offer protection only to health care professionals who object to taking part in the provision of MAID. They would not apply in circumstances where a health care professional may wish to provide MAID but is coerced or intimidated to abstain from providing it. I have to question why we would resort to creating a new criminal offence to protect one health care professional's freedom of conscience but not another's.

Canadians have varied opinions on MAID, depending on their personal circumstances, beliefs and experiences. Despite these diverse views, public opinion research consistently demonstrates strong support for MAID. Our MAID laws recognize the importance of permitting access to MAID as a means of relieving intolerable suffering for competent adults. The laws recognize that those who wish to access MAID should be able to do so, and available statistics show that many Canadians choose to receive MAID.

Since the first legislation in 2016 up until the most recent data released by Health Canada covering 2020, there have been 21,589 medically assisted deaths in Canada. The vast majority of persons who have received MAID had cancer as their main underlying condition, followed by persons who had cardiovascular conditions, chronic respiratory conditions and neurological conditions. This trend is consistent with the leading causes of death in Canada, which list cancer and heart disease as the number one and number two causes of death, respectively. These can be found in the Second Annual Report on Medical Assistance in Dying in Canada 2020.

MAID is a complex and deeply personal issue that engages fundamental rights and interests, both for persons contemplating MAID and for the health care professionals who choose or choose not to participate in the provision of MAID. MAID is anything but straightforward, and we must continue to work together to find appropriate and effective solutions to balance the rights of persons to access MAID with the rights of health care professionals to provide quality care and service in accordance with their conscience. I appreciate the spirit of this bill, but I continue to have real concerns that it would appear to be an improper use of the Criminal Code. I must therefore oppose it.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, the bill we are debating today has to do with protecting the freedom of conscience of health care professionals and practitioners when it comes to medical assistance in dying.

I think we should base our debate on the approach that Quebec took on this matter back in 2010. Quebec studied this issue from 2010 to 2014. The debates were non-partisan. The process allowed for all points of view to be heard and compiled. The focus of the debate was human dignity.

When talking about end-of-life care, we must not forget that the way to protect human dignity lies in freedom of choice. No one can claim to be acting in a patient's best interests if that patient is not allowed to make their own decisions. What is interesting about the Conservatives' bill is that they want the state to be less involved in the economy but more involved in our lives, especially when it comes to death, which is one of the intimate decisions a human being will make.

It is not the state or Conservative members who are going to die in place of the individual, the person who is dying, the patient, so why are they trying to interfere in this decision?

This bill is pointless, and I say this because subsection 241.2(9) already stipulates that no one can be compelled or forced to provide medical assistance in dying against their will.

As I just mentioned, the Quebec legislation should guide us in our debate here today. Section 31 of the Quebec legislation stipulates that medical practitioners cannot be forced to participate directly or indirectly in MAID, and I quote:

A physician practising in a centre operated by an institution who refuses a request for medical aid in dying for a reason not based on section 29 [which sets out all the conditions that a doctor must meet before deciding whether to provide medical assistance in dying] must, as soon as possible, notify the executive director of the institution or any other person designated by the executive director and forward the request form given to the physician, if that is the case, to the executive director or designated person. The executive director of the institution or designated person must then take the necessary steps to find, as soon as possible, another physician willing to deal with the request in accordance with section 29.

This means that a patient who is dying and highly vulnerable should not be burdened with having to take the steps I just mentioned. The bill the Conservatives are introducing today would do just that. It would force these individuals to take those steps at the most vulnerable time of their lives, when they are dying or about to die. However, medical practitioners can refuse to participate directly or indirectly in MAID.

As we heard during the Standing Committee on Justice and Human Rights' study of Bill C-7, some practitioners, citing freedom of conscience, are currently refusing to abide by the Collège des médecins du Québec's code of ethics and forward the request. In other words, they are ignoring the request, which they are not allowed to do.

In Quebec, conscientious objection is defined as follows: “Health professionals must not ignore a request for medical aid in dying. However, a doctor may refuse to administer medical aid in dying because of his or her personal values. The doctor must notify, as soon as possible, the executive director of the institution”.

That is the issue. The Conservatives have introduced a bill to add a provision to the Criminal Code that would make what they call intimidation in health care facilities an offence.

This would be a situation where a health care professional dealing with a family supporting a dying patient—a father, a mother, a brother, a sister—offers end-of-life options without ever mentioning medical assistance in dying. That is the kind of scenario we are talking about.

Quebec was a leader in this area and contributed to advancing the legislation, but there is still a lot of resistance on the ground when a patient requests medical assistance in dying. That can manifest in various ways. The surprising thing is that this resistance stands in stark contrast to what I consider the essence of Quebec's legislation, which was to integrate end-of-life care into the palliative care continuum.

In the current debate, there is one side advocating for palliative care and another advocating for medical assistance in dying. Quebec's legislation did not fall into the trap of such unnecessary division. Palliative care should be accessible, and the continuum of palliative care can give rise to a request for medical assistance in dying. A request for MAID emerges when a patient is given the opportunity to make a free and informed choice.

A person's dignity must not be defined by how they die, and it cannot be compromised because death is considered to be distasteful. To respect a human being is to respect their dignity, and that means respecting their independence and capacity for self-determination until their last breath.

The law enshrines the principle of self-determination throughout our lives, especially when it comes to medical decisions. No one can interfere with my person without my free and informed consent. Why then, at the most intimate moment in my life, would the state interfere in my life and take away my right to self-determination? I can only make a free choice if the practitioner is able to offer me all the choices, including access to palliative care, palliative sedation, and medical assistance in dying. This is a decision that only a dying person can make.

These types of bills and debates take us away from far nobler objectives. There is nothing new here to crow about; it was already set out in the legislation.

I would like members to understand why the Bloc Québécois will oppose this bill. We oppose this bill because at present, in Quebec, some people requesting MAID in a hospital are not being admitted to a palliative care unit. It is shameful that people at the end of their lives must live their last moments in a place that is far from peaceful and far from what is recommended as appropriate for dying with dignity. Why oppose that?

We must focus our efforts on having a continuum of care, working to ensure that palliative care is as available and accessible as possible in all forms, whether at home, in hospices, or elsewhere. A request for assisted death must be viewed not as a failure, but as a success in accompanying an individual towards death.

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

Madam Speaker, I am pleased though a bit surprised to be speaking on Bill C-230. Less than a year ago, on May 27, 2021, we were in the House debating Bill C-268, the very same bill from the very same member for Carlton Trail—Eagle Creek. While I am a bit in awe of the member's ability to place so highly in the random draw for Private Members' Business in two successive Parliaments, I am also at a bit of a loss to explain why the member would squander her luck on this bill.

There are two reasons I say this. As MPs we get limited opportunities to place bills directly before the House. I had that opportunity in 2013, and I used it to put forward Bill C-279, which sought to add gender identity and gender expression to the list of prohibited grounds for discrimination in the Canadian human rights code and in the hate crime section of the Criminal Code. Though many thought it unlikely, the bill did pass the House with support from MPs from all parties. It took a lot of work to put together that coalition of MPs. While my bill followed a somewhat torturous path, there was always a path forward and it became law.

I wonder why it is that having heard so clearly, in speeches less than a year ago, that there was limited, if any, support for this bill outside her own party, the member for Carlton Trail—Eagle Creek has brought it back again. Since there is nothing to indicate any change of circumstances or any change of heart, this bill will go nowhere this time as well. Failing to bring forth a bill that might have some prospect for passing or reintroducing this bill instead of bringing forward a new bill presenting ideas not already debated here in the House leads me to call reintroducing this bill, at best, a missed opportunity.

The second reason I have for declaring the reintroduction of this bill a lost opportunity has to do with the bill itself. This bill picks up a tiny portion of the extensive and important debates on medical assistance in dying that took place on Bill C-14 in Parliament in 2016 and again on C-7 in the last Parliament. It seeks to take one small and very debatable point and turn it into a wedge issue in the House.

We are waiting for the Special Joint Committee on Medical Assistance in Dying to get down to work on outstanding important and critical issues around medical assistance in dying, but as that committee has yet to get under way, I want to take this opportunity today to restate the principle that has guided New Democrats through these debates.

We believe that medical assistance in dying is an important tool for helping to end unnecessary suffering for patients facing end-of-life issues and for avoiding the unnecessary suffering of their families, who have to accompany them on this journey. This is the reason New Democrats will always defend the right of access to information about MAID and access to the service for all those who qualify for assistance in dying and choose to proceed.

In the debate on Bill C-7, many issues arose concerning the challenges Canadians face at the end of life, some of which Bill C-7 addressed directly and some which have not yet been addressed. Two important concerns were front and centre, and these, for me, were the most important. The first was to help alleviate unnecessary suffering by eliminating the waiting period, which was a cause of great concern for patients who feared loss of capacity before they could complete the waiting period and thus make them ineligible for medical assistance in dying and forced to consider suffering.

The second was a change allowing a waiver of final consent. This is a provision I know quite well, personally, as a friend of mine chose to go earlier than she would have liked because of a brain tumour and her fear that she would lose capacity to consent at the last moment and, in doing so, have to continue making her family suffer.

A second challenge was also debated in Bill C-7. How do we preserve as much autonomy as possible for Canadians who are dying? Most of the issues related to this still have to be dealt with at the special joint committee. This includes questions of advance directives, the question of access to MAID for those with mental illness and for mature minors, and whether protections for people with disabilities from being pressured to seek MAID are adequate. I remain frustrated with the delays in dealing with these very important issues. The bill before us is not one of those.

A third challenge that came up in the debate on Bill C-7 was access to services at the end of life. We learned there are a great many gaps in services in our Canadian health care system for those who are facing death. There are gaps in diagnostic and treatment services depending on where one lives, whether it is a major city with excellent facilities or a rural and remote area. We learned of important gaps in palliative care.

However, instead of addressing these challenges, the challenges of autonomy and the challenges of access to services, Bill C-230 is about something else altogether. What this bill would do is override a patient's right to access information about and to have access to legally provided medical services, based on the personal beliefs of a service provider.

Let me put that in plain language. Let us suppose there are a variety of treatments available to a patient. It does not really matter in this case what they are. If a medical professional believes that one of them should not be available, this bill says there is no obligation on that professional to make sure patients find out all the options available to them. Professional organizations, like colleges of physicians and surgeons, and colleges of nurses, have found this to be unethical behaviour, so they require doctors, to varying degrees, to refer patients to someone who is supportive of those services and who is available to provide those services.

This requirement to refer exists in its strictest form in Ontario as the right of patients to an effective referral, meaning a referral to a health care professional who is available, capable and willing to provide that service. This has been upheld by the courts as a reasonable compromise between the rights of patients' access to medical issues and the conscience rights of service providers. That is the main reason I cannot support this bill. If passed, it would result, on a very real and practical basis, in the denial of access to necessary health services for many Canadians.

Many communities have a very limited number of doctors and if one of those doctors, or even more than one of those doctors, is unwilling to let their patients find out about medical assistance in dying, then we are condemning those Canadians to suffer at the end of life in ways that other Canadians would not have to suffer. No health care professionals are in fact required by law to participate, and that is why I find titling this bill “intimidation of health care professionals” disingenuous at best. Is requiring a referral actually participation in medical assistance in dying? Clearly it is not, and trying to torque a requirement to provide information into participation helps no one understand the real issues of conscience involved in medical assistance in dying.

An equally important reason for opposing this bill is the dangerous precedent that this bill would set. Its role as a potentially precedent-setting bill has already been noted by anti-choice advocates who have been vocal in their support for this bill. They recognize that it would provide a precedent for denying referrals for access to contraception and abortion services, and I want to point out that denials of service and denials of information are very real in our existing Canadian medical care system.

This bill would also be a very bad precedent for current attempts to deny transgender minors the counselling and medical services they need to affirm who they are. Without access to services that others may think are inappropriate, this will leave families with trans minors struggling to find the information and support that their kids really need. If this kind of precedent is allowed, medical professionals would not have to provide a referral to someone who would be providing a medically necessary service.

As I approach the end of my comments today, I cannot end without mentioning yet another unfortunate precedent set in this bill, and that is its use of inflammatory language. I have no doubt, as I said in my question to the sponsor of this bill, of her personal convictions and their strength. However, as sincere as they may be, the language used in this bill conjures up a spectre of the use of violence to intimidate medical professionals, something of which there is absolutely no evidence of happening in Canada. Invoking the spectre of violent intimidation is certainly not conducive to an informed debate on the real issues that are in question here.

I will close my comments today by restating that, on principle, New Democrats are opposed to any legislation that would limit access to Canadians seeking information about or the service of medical assistance in dying. No matter how strong the beliefs others may hold, this right exists to access medically necessary services. There is no doubt that the end of life is a difficult moment for all families, and medical assistance in dying, I still believe, is an important way of ending unnecessary suffering both for patients and families at the end of life. I would not like to see anyone denied access to information they need to make a choice that protects their own autonomy of how their lives end. At this point, let me salute the health care professionals who assist patients and their families through this very difficult process.

Once again, I lament the tendency of not just this member but, indeed, many Conservative members of the House to use private member's bills for scoring political points and sharpening divisions in the House—

[An hon. member]

Oh, oh!

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

—instead of looking for opportunities to work together for the common good of Canadians.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Before I go to the next speaker, I want to remind members to afford the respect of the House to others when members have the floor. It is really important to have that respect. I am sure that members do not want to be interrupted when they are speaking.

Resuming debate, the hon. member for St. Albert—Edmonton.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Madam Speaker, I rise in strong support of Bill C-230, the protection of freedom of conscience act, introduced by my friend, the member for Carlton Trail—Eagle Creek.

The bill before us is much-needed legislation to protect the charter rights of medical professionals who conscientiously object to providing or otherwise participating in medical assistance in dying. I want to commend the member for her steadfast leadership in championing conscience rights and for bringing this bill back to the House, as she introduced a similar bill that died on the Order Paper in the last Parliament.

Medical assistance in dying raises profound legal, moral and ethical questions. The trial judge in the Carter decision, which struck down the Criminal Code prohibition against physician-assisted death, stated, “The evidence shows that thoughtful and well-motivated people can and have come to different conclusions about whether physician-assisted death can be ethically justifiable.” This is true of patients, and it is true of medical professionals.

Medical professionals have a duty to do what is in the best interest of their patients and to provide the best possible advice based upon their judgment and experience, all of which are grounded on moral and professional convictions. In the case of medical assistance in dying, there are professional, moral and ethical considerations of the highest weight.

In the Carter decision, the Supreme Court predicated its decision on two things: a willing patient and, as importantly, a willing physician. At paragraph 132 of the Carter decision, the court said that nothing in its pronouncement would compel medical professionals to participate in MAID. The court went further in stating that, “However, we note...in addressing the topic of physician participation...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief.” In other words, again, it requires a willing patient and a willing physician.

Now, there are those who would say that this legislation is redundant, that it is not needed, and that in terms of medical assistance in dying, conscience rights of medical professionals are already protected. They would point to the pronouncement in Carter. They might also cite Bill C-14, which includes a preamble that expressly recognizes conscience rights as well as a “for greater certainty” clause in the Criminal Code, which simply provides that “for greater certainty, nothing in this section compels an individual” to provide MAID.

While the intention of Parliament was to protect the conscience rights of medical professionals when Bill C-14 was debated and passed—and I was there for, and actively participated in, that debate and the study of that bill at committee—in practice, conscience protections and the rights of medical professionals are not being respected across Canada. There is a gap, and that is why, when Bill C-7 was studied at the justice committee, we heard from medical professionals who expressed serious concerns about pressure and coercion in providing MAID.

Indeed, the Ontario Medical Association wrote to our committee and specifically called on the committee to amend Bill C-7 to provide greater conscience protections for medical professionals, given that the “for greater certainty” clause, although better than nothing, simply does not have teeth. It is not enforceable. In that context, while the Criminal Code does not compel a medical professional to provide MAID, there is nothing in the Criminal Code that specifically protects medical professionals when they are pressured or coerced to provide MAID. This bill addresses that gap and would close it by establishing two targeted offences; namely, it would make it an offence to intimidate or coerce a medical professional with regard to providing or participating in MAID, and secondly, it would make it an offence to dismiss or refuse to hire a medical professional solely on the grounds that they object to participating in MAID.

While this legislation would protect the rights of medical professionals, it must also be emphasized that this bill would just as much protect the rights of patients. The bill would protect the rights of patients by protecting the physician-patient relationship. It would do so by safeguarding the ability of medical professionals to provide their best advice and judgment, free of pressure and free of coercion, to a patient who is considering medical assistance in dying. It would protect patients by protecting their right to a second opinion. There can be no second opinion, or at least a guarantee of a second opinion, in the face of coercion or pressure to provide medical assistance in dying. There can be no second opinion when the only choice offered to a patient is medical assistance in dying as a result of pressure and coercion.

The need to safeguard the patient-physican relationship, which this bill works toward achieving, is all the more needed in the face of the radical expansion of medical assistance in dying in Canada with the passage of Bill C-7, which removes critical safeguards, including the criterion that death be reasonably foreseeable and opens the door to medical assistance in dying for persons who are suffering solely from a mental illness, even though it is never possible to predict when someone who is suffering from mental illness can get better. It is never possible to predict irremediability in the case of a solely mental illness. As a result of the removal of those critical safeguards, vulnerable patients are put at greater risk.

When the conscience rights of medical professionals to exercise their best judgment are protected free of intimidation and coercion, the rights of patients are equally protected. This is a timely, targeted and necessary piece of legislation that would protect the rights of medical professionals and their charter rights and the rights of patients. I urge its passage.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The time provided for the consideration of Private Members' Business has now expired. The order is dropped to the bottom of the order of precedence on the Order Paper.

The House resumed from March 25 consideration of Bill C-8, An Act to implement certain provisions of the economic and fiscal update tabled in Parliament on December 14, 2021 and other measures, as reported (with amendment) from the committee, and of the motions in Group No. 1.

Economic and Fiscal Update Implementation Act, 2021

[Simon-Pierre Savard-Tremblay, Bloc, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, historically, the powers that be have always used crises as an opportunity to build an increasingly unitary government and spread its tentacles. The so-called Canadian Confederation has always been predatory and oppressive.

This was true after the Patriotes rebellion of 1837 and 1838 was quashed by the Act of Union, which was sanctioned following the recommendation of the fundamentally racist Durham report. It was true after the world wars, when taxes that had officially been called temporary became permanent.

It was also true after the 1980 referendum on sovereignty-association, with the unilateral repatriation of the Constitution, which Quebec still has not signed. It was true after the 1995 referendum, when the government unilaterally cut provincial transfers. I remind members that Ottawa used its new surpluses to create a plethora of programs, while Quebec was forced to slash funding for public services.

It would have been really naive of us to believe that the government would not use the COVID‑19 crisis to spread its tentacles into new areas it had no reason to be in.

Budget 2021 gave us a taste of that by setting up a structure of federal intervention in areas under provincial jurisdiction. The Liberal-NDP alliance, the new ultracentralist coalition in power, will be more successful than ever at cloaking its subjugating and imperious ambitions in progressive language.

The 1% tax on underused housing owned by foreign developers proposed in Bill C-8 is a prime example of that.

I want to make one thing clear. This is a good idea in and of itself. I had the opportunity to talk about it a few weeks ago, and I said that it is a good idea on paper, in principle, because it seeks to prevent speculators from buying and selling based on the ups and downs of the market. There is no doubt that real estate speculation is a real problem right now, given that the housing situation is on the brink of disaster.

It should be noted, however, that Ottawa has been shirking its responsibility to provide appropriate funding for the construction of social and affordable housing since the 1990s and that those cuts deprived Quebec of 80,000 housing units. That little dig at the federal government aside, the tax on real estate speculation is a good measure, even if it is a very minor one.

However, just because an idea has the potential to address a legitimate problem does not mean that the federal government should violate Quebec's sovereignty and interfere in its jurisdictions. That is why we are calling this tax the “invasion tax”.

On February 17, 2022, constitutional expert Patrick Taillon explained to the Standing Committee on Finance that this idea comes with some serious negative consequences.

The ultimate goal of this so-called invasion tax is to set some parameters surrounding the right to housing, which is an explicit and exclusive jurisdiction of Quebec and the provinces, and the government wants to do so without any prior consultation or agreement with the provinces.

I remind members that successive governments in Ottawa have boasted about engaging in co-operative federalism, which is a chimera. The concept of co-operative federalism has taken on several names over the years, but it is actually asymmetrical or open federalism. This would not be my choice, as I would opt for independence over unco-operative federalism. This is a particularly centralizing direction for federalism.

Mr. Taillon explained that if this legislation is meant to regulate the right to housing, then it is likely unconstitutional. The pith of the bill goes beyond the jurisdiction of Parliament; it is a provincial jurisdiction.

Ottawa used its usual creativity to try to find a way around the division of powers that it has an obligation to respect, so this is an attempt to disguise a regulatory measure that falls under Quebec's jurisdiction as a tax measure.

This is the very first time that Ottawa has dared to interfere in the area of property taxes by seeking to penalize non-resident, non-Canadian second home owners. If this bill is directly related to the housing act, then we must conclude that it is unconstitutional.

It goes without saying that no one here is challenging the government's right to impose new taxes. If the primary goal is not to generate revenue but instead to limit or discourage certain behaviours related to real estate speculation, then this is more of a regulatory measure than a new tax, and it must be associated with an area of jurisdiction, in this case housing, which has always been governed by the provinces.

Without an agreement with Quebec and the provinces or their collaboration, a federal property tax would compromise the fiscal balance, which I would politely describe as already being fragile. Why would we let Ottawa borrow a tax tool that is not its own from the various local authorities, namely the municipalities and school boards, that need this tool themselves?

That imbalance will only grow in the coming years, especially given rising health care costs that Ottawa is still refusing to finance appropriately. It is important to emphasize that the Parliamentary Budget Officer's Fiscal Sustainability Report, which was released in June 2021, confirmed that the federal government still has financial flexibility, in contrast to the provinces, which have none and are in fact facing long-term viability problems. This really is not the time to be interfering in their business.

History has made it very clear that, once Ottawa gets its hands on tax fields, it never lets go. Been there, done that. Take corporate income tax, for example, which was a supposedly temporary measure brought in after the First World War, or personal income tax, another supposedly temporary measure brought in after the Second World War.

This property tax sets a dangerous precedent because Ottawa will inevitably have to set up various delegation of authority tools and infrastructure to manage it. This tax does not work like other federal taxes, so it will require new systems. As Mr. Taillon explained, once the mechanism to administer property tax is in place, it will be hard for Ottawa to resist the urge to look for more good ideas to fill that space.

Given the new ultracentralist coalition in power, I think I am entitled to feel that this will inevitably hurt the provinces, municipalities and school boards.

My political party proposed a single amendment to address this issue. We tried to find a compromise by proposing that the property tax measures apply only if the province agrees. That would just make sense, but unfortunately, the Bloc Québécois's amendment was deemed out of order by the Liberal committee chair, without even being debated. That is too bad.

In conclusion, taxation powers are directly connected to political sovereignty. In usurping an exclusive jurisdiction of the Quebec state, the federal regime is becoming more and more oppressive and Quebec is losing its agency and its power. Independence has its price, to be sure, but dependence is even more costly. This invasion tax is yet more evidence of that.

[Colin Carrie, Conservative, Oshawa, ON]

Madam Speaker, my colleague talked about similar worries that I have about the continued centralization of government, and he talked about housing, which I am hearing a lot about in my community. The Conservatives have a solution: Motion No. 54. It is asking the federal government to abandon its failed first-time homebuyer initiative, which has only helped 15% of its target.

I wonder what the member thinks about supporting that motion. Also, what is he hearing from young people in his community? I am hearing that young people are starting to give up on the dream of home ownership. Could the member please comment on this important initiative?

[Simon-Pierre Savard-Tremblay, Bloc, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, needless to say, the housing system is in crisis. My colleague and I agree that there is a problem and that the solution being proposed is not the right way to go.

However, I think our political parties disagree on whether a real estate speculation tax should be imposed. I personally am in favour of this principle, but I simply think it was introduced in the wrong legislature.

I think my colleague also agrees with me on centralization.

However, our party differs from the Conservatives on another point. The Bloc believes that funding for housing needs to be completely overhauled so that it is not just private developers who benefit, but also community organizations, non-profit organizations and housing co-operatives, because they are the ones that know the real needs.

I also want to point out that the funding still needs to be rolled out. Ideally, that money would be sent to Quebec, and Quebec would take care of it. However, the federal government's withdrawal has deprived Quebec of roughly 80,000 housing units since the 1990s. As long as we pay taxes to Ottawa, we have a right to expect a fair return on our investment.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, my colleague spoke a lot about jurisdiction. I wonder if he is aware that the Supreme Court of Canada has declared that health care is shared jurisdiction in this country. I wonder if he is aware that the words “health care” do not appear in the Constitution at all. I wonder if he is aware that the only power given to the provinces in our Constitution is the establishment and maintenance of hospitals. Finally, I wonder if he is aware that the Canadian health care system, which Quebeckers and all Canadians treasure so much, would not exist without federal legislation that established five conditions for the transfers of funds.

This is the system that he and the Bloc Québécois want more money for from the federal government. Is he aware that this system is dependent on federal jurisdiction, which ties the money to conditions?

[Simon-Pierre Savard-Tremblay, Bloc, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, I am perfectly aware. There is a lot to read and study in the Constitution, which Quebec never signed.

It is also clear that delivering health care is a provincial responsibility, that the legislation governing health transfers to which my colleague referred is not being respected and that adequate funding is not being provided.

I thank my colleague for asking me whether I am aware of all this. My answer is yes, of course.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I want to add to my New Democratic colleague's thoughts. Canadians, as a whole, recognize and want to see a national government that truly cares, provides for them and is there in a tangible way with regard to health care. That is one of the reasons we have been advocating for national health care standards.

Would the member not recognize that even people in Quebec, along with other Canadians in all regions of the country, want to see a national government play a role in long-term health care and mental health? Would he at least acknowledge that as a fact?

[Simon-Pierre Savard-Tremblay, Bloc, Saint-Hyacinthe—Bagot, QC]

Madam Speaker, Quebec has no lessons to learn about establishing a public and universal system. It has been a pioneer in the field. The system is poorly funded, actually underfunded. That is the problem.

That being said, if the rest of Canada is prepared to live with Canada-wide standards or programs and the provinces agree, then let it be on condition that there is always a right to opt out with full compensation, no matter the reason. Accordingly, a province that disagrees, like Quebec, should be able to opt out, take the money, and say that it will adjust its programs appropriately, the way it wants to do it.