Mr. Speaker, tonight, I am addressing the House on Bill C-41, the latest attempt to further expand the cases in which a doctor or nurse practitioner is legally permitted to end the life of their patient, a practice which is generally, if euphemistically, called MAID in Canada.
The bill proposes to allow the use of so-called advance directives for MAID. Bill C-41 would allow a patient to sign an advance directive permitting a doctor or nurse practitioner to kill them under certain future circumstances, perhaps years or decades in the future. Necessarily, other people would have to assess and determine whether the conditions in the signed document had been met. The patient would have delegated the power over life and death for themselves to another person. Bill C-41 would eliminate the legal requirement that a person consent to their death when they are dying. It would replace the requirement for contemporaneous consent with advance consent.
Of course, advance consent is inevitably less clear in practice than contemporaneous consent. In the signing of an advance directive, a person would be making a prediction about how they think they would feel under certain future circumstances that they likely have not experienced before. They would be making a prediction about how their future self would feel and what their future self would want. They would be judging the situation from the outside without lived experience.
In practice, people would likely be presented with pro forma advance directives based on a common template and told that typically people in such a situation sign something like this or want something like that, etc. We already know these kinds of proposals to people who are not asking for them are occurring. Perhaps these pro forma advance directives would be given to people right after a new diagnosis is given, when a person is understandably scared about the unknown and about what they would feel under new circumstances, and they would trust authority figures and sign these pro forma documents.
This would then provide those same authority figures with options, but certainly not clarity. They would later look at a patient and compare that pro forma directive with their assessment of the patient's current condition. Do they seem happy, content? Is their life worth living? How does what they wrote or signed on the page compare to what we guess might be going on in their head today?
Certainly in so many cases there would be a variety of different interpretations. Perhaps the burnt-out spouse and caregiver would think the conditions of the advance directive are met, while the adult children would think otherwise. Importantly, the law as written would not require the patient to be asked or informed again once they have written the advance directive. One day the clinician changes the substance of what is in the patient's IV, and the patient dies. “It was her wishes,” says the doctor. “No, it wasn't”, say the grandchildren, but at the end of the day, she is dead, because someone killed her based on their interpretation of a piece of paper that she signed years ago. Welcome to Canada.
Maybe grandmother was a bit of a people pleaser. Maybe she talked about her illness in slightly different ways to different people, depending on what she thought they wanted to hear. This is very normal, of course. All of us are people pleasers to some extent, but Bill C-41 would require other people to interpret her feelings, her sufferings and her wishes, and to turn them into their own judgments about whether she should be killed, again with no obligation to talk to her about it once the initial paper had been signed.
Families would inevitably be deeply divided over who decided to kill Grandma and whether the conditions of the signed document were met. Confusion is inevitable. The ambiguities are legion, involved in assessing someone else's suffering based on a directive made long ago by a person who at the time had no experience of the illness. This means in practice that someone else would decide when and whether someone dies, and they will not ask before they kill them.
Underneath these practical problems is a deeper moral question about advance directives. Can I bind my future self in matters as weighty as life and death? Can I make a choice that would permit someone to kill my future self, especially when that self may not remember or be conscious of the previous decision?
When we allow advance requests today, it is purely in the case of a negative, a person signing an order to not have something done to them. Signing an advance request to not have something done to me is very different from a directive that licenses someone to do something to me when I am not aware of what is happening and under nebulous, difficult-to-define circumstances.
Not only do we not allow this type of definitive advance determination, generally speaking, but we have done painstaking work to correct a grave moral error of the past in this regard, the idea that consent, once given, is given forever.
The most obvious context in which this applies is sexual consent. Recognizing the need for contemporaneous consent in every sexual encounter was a real and important moral development. Previous but clearly flawed legal doctrines of the past regarded consent to marriage as furnishing a definitive future consent to sexual relations, and thus did not prosecute the offence of marital rape. It was a critically important and clearly positive moral development to recognize the importance of contemporaneous consent in every sexual encounter, that receiving consent in the moment is necessary, regardless of a past commitment.
Everyone in the House agrees, I am sure, that marital rape should be prosecuted. It is hard for me to understand, then, why some members would regard advance consent in matters of death as permissible, while rejecting it in matters of sexuality. Introducing the idea of violating a person's autonomy on the basis of a piece of paper signed in the past would seem to be a step in undoing the moral progress that has been made in this regard.
A person also cannot consent to slavery. Some, though certainly not all, systems of slavery are based on the idea that a person can sell themselves, an act through which the present self binds the future self. Today we would understand such systems as grossly immoral and as representing a denial of human dignity and of autonomy, yet death is more final than slavery. If the past self cannot bind the future self in the case of slavery, then why would it be so in the case of death? What began in the name of autonomy has lost the plot by now denying the autonomy of the present self to adapt to new circumstances and to make new choices.
The practical and philosophical problems inherent in the operationalization of advance directives for MAID likely informed the decision of members of the Conservative Party of Canada to explicitly adopt a position opposing advance directives for MAID. I am proud to be part of a party that officially opposes this expansion in its member-driven policy document.
These problems have led virtually every other country in the world to also reject going down this road. Most notably, I think the problems with such advance requests also informed the decision of the Justin Trudeau Liberal government to reject calls to implement a system of advance requests for MAID. In each past stage, there were those who argued for advance directives, yet the Trudeau Liberal government evidently decided, based on the moral and/or practical risks associated with them, that it was not going to go down this road.
However, now we have the new Prime Minister, who is hell-bent on pushing Canada's MAID regime further than Justin Trudeau by pursuing an expansion that even Justin Trudeau rejected. As a fellow Catholic, while not expecting that a shared religious identity would lead us to agree on every issue, I did expect better from the Prime Minister. I expected that he would at least have some sensitivity to the idea of universal human dignity, the need to prevent the devaluing of the lives of people with disabilities and the need to avoid further MAID expansion. It is difficult for me to reconcile his stated convictions with his decision to advance legislation that would allow a patient to be killed in their bed without even being asked for contemporaneous consent.
Canada already has the most radical MAID regime in the world, and the Prime Minister, the Catholic Prime Minister, is now wilfully presiding over the further expansion of a MAID system that is already the most radical in the world. It is frankly hard to tell what the Prime Minister believes at all, even if his frequent reversals of conviction have brought him some measure of political success thus far.
All of these events call to mind the alleged remark of Pope Urban VIII following the death of Cardinal Richelieu. He quipped, “If there is a God, the Cardinal de Richelieu will have much to answer for. If not...well, he had a successful life.” This is worth contrasting with the observation of St. Teresa of Calcutta, who said that we are not called to be successful, but faithful. The point is one of general application, regardless of fundamental beliefs or philosophical commitments; that is, to be a statesman is to stand for something.
Our calling as members of Parliament is to faithfully defend the national interest of Canada and the common good, to defend it from the shame that it already faces as a global pariah and embarrassment when it comes to the fundamental rights of people with disabilities. On that basis, I will fiercely oppose this expansion, as it would turn my country into a place where patients are killed without even being asked, based on a document that they signed years ago.
As a brief final coda, I note that Bill C-41 contains provisions around limiting the application of MAID in the cases of mental health. These provisions on mental health are supported by over 90% of MPs and could easily be proposed separately and adopted rapidly. That debate has thankfully already been won, but it is the height of cynicism for the government to tie those provisions to its radical new expansion of MAID.
We must defeat this bad, cynical bill. Of course, I agree with the mental health provisions in the bill, but those could easily be passed in a separate bill in 48 hours. No one should fall for this devious legislative trick. That is why we must oppose the expansion in Bill C-41.
