Debates of Nov. 4th, 2026

Medical Assistance in Dying Safeguards Act

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

Madam Speaker, I am opposed to this bill on the grounds of the advance directives proposal. There is nothing in the bill that would even require that a person who had previously, maybe years before, signed an advance directive be consulted or told what is about to happen to them.

The bill would allow a person to be killed based on a piece of paper they signed perhaps years before, without informing them what is about to happen to them. It is obviously a bit of a stretch to say, in the name of autonomy, that somebody can delegate the power of life and death for them to someone else. It means that somebody else would make that decision for them, again, without asking them or without telling them, potentially, and would have to assess, external to them, what is or is not intolerable in the particular circumstances.

The person signing the advance directive would do so before they even have the lived experience of that condition. If I get a diagnosis today and am asked to sign a document about something in the future that I have never experienced, I am obviously doing that in relative ignorance of that experience.

Does the member share these concerns at all about how this would work in practice? Even if she likes the idea of advance directives in theory, what would it mean in practice when somebody else has the power of life and death over a patient on the basis of something they signed years before?

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, this is a perfect example of how complex the issue really is.

First of all, no one would be offered a document to sign. People would take the initiative, once they have received a diagnosis, in consultation with their medical provider, and they would decide. They would have to do the research. In fact, the legislation would protect people from having this offered to them or forced upon them. I know that is a concern of our Conservative colleagues, and it is one that is addressed in this legislation. Again, we are getting back to how much faith we put in individual Canadians to make autonomous decisions for their own care.

For something in the future that they would have to deliberate, it would be a discussion they would have with their doctor, with their family and, if they are a person of faith, with their creator, and they would ultimately make the decision for themselves.

At any point in time in the process after someone decides to sign an advance directive, they could withdraw it. In fact, they would not have to formally withdraw it. They could just say to the provider of MAID in the moment, or prior, that they are not willing to move forward. In fact the legislation even says if they make sounds or gestures that indicate they may not want it administered, then the provider could not administer it.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, my colleague talked about the history of MAID in Canada. I hope my colleague knows that Bill C-14 did not respond to the Carter decision, because Ms. Carter and Ms. Taylor were not terminally ill, and Bill C‑14 enshrined a flawed Quebec law. Essentially, that legislation should have addressed the cases of Mr. Truchon and Ms. Gladu. However, the onus once again fell on Ms. Gladu and Mr. Truchon to assert their constitutional rights and to invoke the Carter decision in the Baudouin case. Neither of them was terminally ill, and natural death was not reasonably foreseeable.

With respect to mental disorders, is my colleague aware that all the experts said that this blanket exclusion is discriminatory and that, if we postpone the debate indefinitely, we will never again be able to have this debate here? This means that vulnerable people with mental disorders who have been suffering for decades will still have the burden of taking their cases all the way to the Supreme Court to assert their constitutional rights.

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, I thank my colleague for that good question.

In my remarks, I mentioned that I was on the joint committee with the hon. member, and there was vigorous debate and certainly difference of opinion on a number of factors. I take his point with respect to what he is saying for folks who are experiencing mental illness as the sole underlying condition. I had an experience of talking to someone in my riding who was very disappointed that as someone with mental illness, they would not be able to access MAID, given the recommendations of the committee. As I mentioned, it was primarily because the provinces and territories had shown they were not ready to assess and consistently and safely administer MAID in those situations.

My colleague also referenced the extensive case law and the legal history. I am sure the law will continue to develop, as it has over the past 10 years, but right now we find ourselves here with this very important comprehensive piece of legislation that I hope we can have his support on.

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

Madam Speaker, I wonder if my Liberal colleague could provide us with a definition of intolerable suffering. A doctor would have to somehow decide that somebody has intolerable suffering. That person is not able to communicate with them, but they have made an advance request. As far as I understand, there is no definition at this time of the actual wording “intolerable suffering”.

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, sometimes in law, definitions are left broad on purpose. We want to ensure that the provinces that would choose to come on board with this would have their own requirements, their own regulations. Again, we want to ensure that medical providers and the people who go to them seeking care and perhaps choosing MAID have a discussion about what that means. It is impossible to define it in black and white in any sensible way, because there are so many vastly different ways that people can experience intolerable suffering.

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

Madam Speaker, I want to address the issue of courts and of public discussion and debates that have taken place over the years. I remember, from the early 1990s, the late Sue Rodriguez and what she ultimately had to go through. Her case went all the way to the Supreme Court. I believe it was a split decision, 5-4 or something of that nature, and she lost.

The point is that we have been debating this issue for decades now. When I reflect back, I think it is important that Parliament address the issue head-on, which is what I see Parliament continuing to do, and hopefully there will be progress.

I wonder if the member could provide her thoughts on the importance of public opinion, courts and so forth?

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, as I said, the split decision in Rodriguez actually exemplifies how complex the debate is, because it is a very personal choice. It is a very personal decision. Each of us brings value lenses to this discussion. In fact, that is precisely why we need to let individual Canadians make these decisions for themselves. They have to be properly informed, and they can be in consultation with whomever they choose, such as their family, but it is a choice we give to Canadians. In fact, the Supreme Court has told us that it is enshrined in the charter under Canadians' section 7 rights of liberty and security of the person.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Madam Speaker, I did appreciate the opportunity to work with my colleague opposite on the special joint committee. She is very passionate about this issue. She actually has co-hosted an event with Dying With Dignity Canada. The CEO of Dying With Dignity said the following: “Dying With Dignity Canada envisions a world where everyone who wishes to consider a MAID death can do so.” There is no acknowledgement in that line of any medical condition or any suffering whatsoever. Does my colleague agree or disagree with that vision?

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, in the House and around the committee table, we had the great benefit of hearing from so many people from a variety of backgrounds and with differing perspectives. In fact, it was a journey for me, too, to listen, because I came to the table with my own perspectives as well. Opening up one's mind, as we are doing here today in debating this bill, is so crucially important.

What I am envisioning for Canadians is what I have been talking about all along: the right to determine their own decisions with respect to their bodily autonomy and how they want to, if they choose to, leave this life in the way they choose is best for them.

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

Madam Speaker, the member pointed out that this legislation says that if a person were to resist, then the act of ending their life should stop, but what she does not acknowledge and should, I think, is that the legislation would not require that the person be informed before their life is taken. Very likely what would happen, based on an advance directive, is that someone would have something put in them without—

[The Assistant Deputy Speaker (Alexandra Mendès), Alexandra Mendes]

I have to allow the hon. member to provide a very brief answer.

[Kristina Tesser Derksen, Liberal, Milton East—Halton Hills South, ON]

Madam Speaker, I am without the benefit of hearing the entire question. However, no medical practitioner is going to want to put themselves in a position where they have administered MAID without informing the person ahead of time.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Madam Speaker, I will be splitting my time with the Leader of the Opposition.

The Liberals have learned absolutely nothing over the past five years from their disastrous planned expansion of MAID for mental illness. They decided to move ahead with this planned expansion before studying the issue. They did so by accepting an eleventh-hour Senate amendment to Bill C-7, legislation that had nothing to do with MAID and mental illness, until of course they accepted the amendment. They then proceeded to shut down debate and ram through the bill without any meaningful debate, consultation or study, thus setting the train in motion for MAID for mental illness.

Had they studied the issue first, rather than recklessly moving ahead with it, they would have heard what has been now made loud and clear by leading experts, including psychiatrists, namely that MAID for mental illness cannot be implemented appropriately and safely. The Liberals, because they did not do their homework, had to bring in two emergency bills to delay implementation. Here we are, five years and four bills later, and they have finally admitted they got it wrong all along and are now bringing forward legislation to put an indefinite pause on MAID for mental illness.

At the same time, here we are again, with the Liberals' recklessly seeking to ram through a new expansion of MAID, this time advance requests, by shoehorning advance requests into a bill to put an indefinite pause on MAID for mental illness, an expansion that will take place unless a bill is passed by March of next year. What the Liberals are doing is shutting down parliamentary debate and parliamentary scrutiny of the complex issue of advance requests. If there ever was an issue that deserves careful scrutiny, it is advance requests, because there are profound legal, ethical and practical issues at play, and there are significant risks.

The most significant risk identified in its 2018 report by the expert panel the Council of Canadian Academies, which is appointed by the government, by the way, is that in the case of advance requests, MAID could be administered against a patient's wishes. That is not an isolated or remote risk. It is a very real risk underscored by Health Canada's data in its annual reports on MAID, which show that each year, anywhere between 10% and 20% of patients who withdraw their consent withdraw it immediately before the administration of MAID.

The possibility that MAID could be administered against a patient's request really gets to the heart of the central issue around advance requests, and that is the issue of consent. On the question of consent, the Supreme Court of Canada, in the Carter decision, said that in order to qualify for MAID, a patient must clearly consent. The court used those words multiple times in that decision, “clearly consents”, which arguably implies that such consent must be contemporaneous. Hence, advance requests raise serious legal questions about whether they fall outside the parameters for MAID set by the Supreme Court, and whether explicit contemporaneous consent is constitutionally required.

Not only are there issues that are legal in nature, but there are also profound ethical concerns involving consent, because when consent is made in advance, it can never be fully informed consent. That is because it is made based upon future assumptions about one's circumstances, capacities or preference, not upon one's lived experience.

There is abundant research into effective forecasting that demonstrates that when a person is diagnosed with an illness or a condition, they are often poor predictors of what the future will look like. As Dr. Romayne Gallagher, a clinical professor in palliative medicine, told the Special Joint Committee on MAID:

...medical and social science literature reminds us that people are poor at anticipating what life would be like with a life-changing illness or disability. People adapt to illness and disability and adjust their needs for a decent quality of life. Many medical conditions have long and unpredictable courses.

If consent cannot be contemporaneous and therefore cannot be fully informed, it raises the question, can there be true consent? If there cannot be true patient consent, then how can we ethically proceed with an advance request regime?

Now, proponents of advance requests often cite individual autonomy, but I would submit that individual autonomy in the context of advance requests is illusory. That is because advance requests necessarily result in not patient consent but third party consent, based upon observations that are often highly subjective in nature. After all, how does a MAID assessor confidently and accurately determine if a patient is suffering intolerably, which is a prerequisite for MAID to be administered, if the patient cannot communicate the degree to which they are suffering? That is what we invite with advance requests, namely, the administration of death based upon third party, often highly subjective observations of patients who cannot communicate and often have no ability to withdraw their consent.

Then there are other issues that need to be considered, including legitimate concerns that advance requests will lead to abuse and coercion resulting in vulnerable persons having their lives ended. There are concerns from a human rights perspective that advance requests undermine human dignity and will lead to discrimination against persons with cognitive disabilities, that a message is being sent that their lives are not worth living and that they are lesser human beings, completely undermining a fundamental principle of human rights: the universal and equal value of all human beings.

All of this underscores the need for careful study and meaningful consultation, none of which has happened, by the way. The Liberals have not done any meaningful consultation since the 2018 expert review, which recommended against moving ahead with advance requests, but instead the Liberals have learned nothing. Here we are again with the Liberals recklessly trying to ram through a complicated expansion of MAID. Canadians deserve better.

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

Madam Speaker, I am going to go back to a question I have asked some of the member's colleagues. I think it is an important question. What I am hearing from the Conservatives, I believe, is not necessarily a fair reflection of the overall opinions of Canadians as a whole.

Does the member have any sense, in terms of the positioning by the Conservative members who have spoken so far, of whether it is truly reflective of what he believes a majority of Canadians might feel about the issue?

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Madam Speaker, on a question of life and death involving an advance request regime, we need to proceed with caution. If the last five years is an illustration of the need for caution and the need to consult, it is precisely that. Yes, public opinion is one thing, but we need to look at how the regime could be rolled out, the risks involved, whether it is appropriate and, if it is appropriate, what safeguards need to be put in place.

Instead of doing that work, the Liberals are trying, yet again, to shut down debate and just ram it through under the deadline with respect to the expansion of MAID for mental illness, with the need to pass that bill to put an indefinite pause on that completely ill-advised and reckless planned expansion.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, I would like to point out to my colleague that advance requests were the flagship recommendation of the first joint special committee. No one opposed them except, of course, my colleague and the Conservatives.

I would like to point out to him that the very principle of an advance request is to be able to work with a health care team to establish the threshold of what is tolerable, in other words, the criteria beyond which a person does not wish to continue their end-of-life in a state of deterioration that can ultimately lead to a level of stiffness akin to rigor mortis. Often, people do not die from Alzheimer's. They die from a host of concomitant illnesses. The bill states that all of this must be assessed in accordance with best practices.

Does my colleague fully understand that, in a sense, his reasoning is not ethical and his objections are not ethical, but rather purely legalistic, based on a theological foundation?

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Madam Speaker, contemporaneous consent and issues around the ability to withdraw, or the inability to withdraw in the case of advance requests, which are fundamental to fully informed consent, are not legalistic issues. Yes, there is a legal element to it, but these are profound ethical questions around whether advance requests can be implemented safely.

The member spoke of the Special Joint Committee on MAID. All I can say is that there was a very limited, cursory review of the issue of advance requests at that committee, which studied multiple issues.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Madam Speaker, I thank my colleague for his work on the Special Joint Committee on Medical Assistance in Dying.

I note that several of the members of the Liberal government who have spoken in favour of stopping the expansion of MAID to people with mental illness were, a few years ago, speaking in favour of expanding MAID to mental illness. The difference of a couple of years was enough for people to realize that this expansion should not be allowed to proceed.

In that context, I wonder if my colleague could offer his thoughts on why we should accept the government's artificial timeline to ram through advance requests when it is more than likely that in a few years, we will reach the same conclusion that we are reaching now on mental health, which is that the safeguards are failing and that can never be adequately woven into our MAID system.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Madam Speaker, I completely concur with the member for Elgin—St. Thomas—London South. There is absolutely no reason the provision for an advance request regime needs to be shoehorned into this bill. For years, the Liberals did nothing around advance directives. They did no studies, they had no consultation, and now, all of a sudden, they drop it into a bill in the face of a deadline to pass a bill by March.

It is completely unacceptable, it is cynical, and it is really just an attempt to ram this through, just as they did with mental illness, without any of the scrutiny that comes with careful study and review.

[Pierre Poilievre, Conservative, Leader of the Opposition]

Madam Speaker, imagine someone's phone rings and the voice on the other end of the line, a stranger, gives them the surprise request that they need to pick up their 26-year-old son at the morgue because of medical assistance in dying. He had no life-threatening illness. He had type 1 diabetes and some vision problems, but other than that, it was just depression. He had been denied medical assistance in dying because he was not eligible.

That was the story recounted to me by Margaret Marsilla, who came to visit me in this building. Kiano was only 26 years old, and although he struggled with diabetes and depression, he was not facing any end-of-life medical emergency. In fact, in Ontario, medical professionals had said he was not eligible. He shopped around for a different opinion and got one from a British Columbia doctor. I met his heartbroken mother in March, and her story is all too common.

In the last few years, we have seen the predictable consequences of a medical assistance in dying regime that fails to protect the vulnerable and even preys on them. Canada has become famous around the world as a cautionary tale for abuses in a system that too often sees death not as a last resort for patients suffering but as a first option for an overburdened health care system.

The statistics are stark. More than one in 20 Canadian deaths are by MAID. If we dig in, the numbers get even worse. One in 10 Canadians knows somebody who was offered medical assistance in dying even though they had no life-threatening condition and all of their conditions were treatable. Almost half of those who died by MAID in 2024 had reported feeling like a burden on family, friends and caregivers, raising the risk of induced death by guilt. Then there are individual horror stories, such as the Canadian Armed Forces veteran who contacted veterans affairs agents asking for government support for his ailments and was instantly offered MAID, or Father Larry Holland, a Catholic priest who went into the hospital for a fractured hip and was offered MAID not once but twice.

These are not isolated cases. Even the BC Civil Liberties Association, which was one of the interveners that sued the government to legalize euthanasia in the first place, now believes the procedure has gone too far. Last year, it was “aware of 'concerning reports' of people being offered MAID in circumstances that may not legally qualify” as well as people accessing MAID as a result of intolerable social conditions, not medical conditions but people living in misery, poverty or loneliness and being told that the best option for them is to die.

The organization called for safeguards to protect the more vulnerable patients so that they do not feel pressured to end their lives. Under these circumstances, the government had no choice but to pause its planned expansion of MAID for mental illness. I am pleased that the Liberals have once again reversed themselves on yet another radical experiment they had planned to impose on the Canadian people. Just as with net zero, mass immigration, catch-and-release criminal justice, legalized drugs and the carbon tax, they have been forced to reverse themselves yet again.

The committee that studied the question heard from doctors who were worried about allowing patients to make a decision in a moment of personal crisis and despair that can and often does get reversed later on. The close link between mental illness and suicide also raises a practical problem. One psychiatrist actually testified that there is a problem, an incoherence, in that “Psychiatry claims it can both prevent suicide in one patient and help finalize suicide in another with [both of them having] the same suffering.”

While I am glad the Liberals reversed themselves on one bad idea, I am disgusted that they have gone forward in the very same bill with another bad idea. In the same bill we are debating, which bans MAID for mental illness, the government would also legalize it for advance directives. These would allow persons to request MAID, at a time when they would not be eligible for it, for a future moment when they become eligible.

Doctors have sounded the alarm at the impossible situation in which this may put them and the family members of the suffering person. Imagine the case of a patient suffering with dementia. They have signed an advance directive, but now they are smiling. They are happy. They enjoy sitting outside with the sun shining on their face. Their grandkids are sitting on their lap, enjoying an ice cream after dinner. However, they have signed an advance directive. Everyone knows that this person, though they have lost their faculties, is happy going on living. What does a doctor do at that point? Do they administer MAID to a patient who looks happy and who everyone knows wants to live on, or do they refuse the directive the government says they have to follow and consider the family?

Most members would be aware of the story of Lisa Raitt, a former member of the House. She recently wrote online about her husband, who has been suffering with dementia for the last 11 years:

“If Bruce had signed an advanced directive, would I have been left to make the decision on when to apply MAiD?

“Even after 11 years, yesterday I saw him smile, laugh, interact and enjoy his meals while being non-mobile, incontinent and non verbal.

“I can promise you, I would ignore any advanced directive. Yes, he is a different man with a different life now but subjectively and objectively he is comfortable and content. I would not believe this Bruce would want to stop living.

“In this case, would the ‘state’ step in to provide MAiD over my objections and experience? We are rushing to a set of really complex entanglements. So much room for harm.”

Instead of looking for more ways to end life, we should be looking for ways to allow people to live the fullest life, with better care, more support, pain treatment, love and compassion.

We also know there is the fundamental problem that advance directives may not be accurate measures of what a patient would actually want in future circumstances. We have all said to ourselves that if such and such were to happen, we would want X or Y. Then when that eventuality comes about, we change our mind because the experience was different than what we thought. The attitude of a young person to death, for example, may be very different from an older person's and may be different from that of the person they become. It would be easy to say that someone would not want to live that or live under those circumstances, but when they find themselves in those conditions, it can turn out to be that life is better than they thought and they no longer desire death.

Many Canadians who are suffering serious health conditions can tell us from personal experience that there is hope they find and comfort they reach in the loved ones who surround them. Assuming that the conditions they live with would be reasons for someone else not to live ignores the experience and risks here, devaluing the lives of people in those circumstances.

I am not prepared to take away from doctors or from family members like Lisa Raitt the ability to act for their loved ones when no one else really knows what the loved one wants and no one else has a greater interest in the well-being of that loved one. These are painful decisions for doctors and families at the best of times. We should not make harder by rushing through dangerous legislation.

Unfortunately, the government has forced me and many others in this room into an impossible dilemma, those of us who want to ban MAID for mental illness and give people hope that they can have a brighter future and can come out of the bottom of the valley and get back to the mountain top. We want to vote to save their lives, but we do not want to vote to introduce new dangers that could end other lives that people would believe are worth living.

That is why we are calling for the government to split this bill. There is no reason to rely on the arbitrary deadline that is necessary to repeal MAID for a mental illness in order to avoid it coming into effect in March, to also then apply it to the swift passage of an extremely complex and highly dangerous new practice that is done almost nowhere in the world and that is fraught with serious risks.

This is literally a matter of life and death. I ask the government to split this bill to allow Canadians and their parliamentarians to express their conscience by voting on each section separately so that we can stand in this place and offer hope, compassion and love to the people who need it most.

[Ben Carr, Liberal, Winnipeg South Centre, MB]

Madam Speaker, I respect a number of the things the Leader of the Opposition raised. I know it is a very difficult topic for many Canadians. I can remember my father, in the final stages of his cancer battle, struggling with what he wanted to do in terms of his directions.

As we know, the bill would decriminalize advance directives. It would not set the framework. It would put forward the conversation, of course, that would take place between the provinces, but really, in this chamber it is about decriminalization. Does the Leader of the Opposition see a path in which, if he were satisfied with a framework that alleviated the concerns he raised in his speech, he would accept the decriminalized element of the process that this bill tries to achieve?

[Pierre Poilievre, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, no I do not, because I do not believe that someone can grant pre-emptive consent for a subsequent death. There is a very serious risk no matter what we do.

Let us assume that I had answered the question with “yes”. That framework would take time. Serious and deadly risks would come with creating a system of rules for people to grant permission to die much later on once their ability to consent is gone, and that would require immense study and surgical precision, which cannot be done with a bill that would be rammed through before Christmas. This bill needs to be split so that we can ban MAID for mental illness and give hope to these people, but at the same time not make the deadly mistake of expanding into the unknown without doing our research.

[Marie-Hélène Gaudreau, Bloc, Laurentides—Labelle, QC]

Madam Speaker, the first thing I want to say is that there is no rush. We have been talking about this for five years, and Quebec has spent years working on it. Let us look at the models in place. They should not be dismissed just because they come from Quebec.

I want to make an analogy. I know someone who has been in politics his entire life. Image matters. Let us imagine that he unfortunately develops Alzheimer's. He makes a request to his loved ones in case there comes a day when he starts to behave completely differently, when they no longer recognize him, when he stops being able to feed himself and when he no longer behaves the way he did when he was in politics. I am not making a link here. When he arrives arrive at a long-term care facility, he keeps wanting to take his clothes off and starts flirting with all the women.

An advance request gives a person a way to say that, if they get dementia or any other disease, they never want their loved ones to let them go through this.

Is that not legitimate in terms of human dignity?

[Pierre Poilievre, Conservative, Battle River—Crowfoot, AB]

Madam Speaker, first of all, just because a person has finished one phase of their life and is beginning another does not mean that their life is over. A person may get sick, but their life still has value. Perhaps they want to continue living, but they are unable to communicate their will to live. I would not want such a person to lose their life.

I think that, in situations like this, we need to provide the best care, the best support and the most love for that person, whether they are a former politician or anyone else.