She said: Mr. Speaker, I would like to begin my comments by acknowledging the depth and quality of the thoughtful work that the other place has undertaken in its review of Bill C-14.
The number of amendments that were presented and thoroughly debated speaks volumes, not only about the complexity of the issue at hand but also about the dedication with which members of the other place sought to improve the legislation.
Bill C-14, as passed by the House of Commons, expressed our policy choice to address medical assistance in dying in a principled and cautious manner. This policy choice was deliberately and carefully crafted. The bill achieves the most appropriate balance between individuals' autonomy in deciding how their death will occur and protection of vulnerable individuals, as well as broader societal interests. These interests include suicide prevention, equal valuation of every person's life, and preventing the normalization of death in response to suffering. Several amendments were made to Bill C-14 in the other place.
The most significant amendment was the deletion of the definition of “grievous and irremediable medical condition”. The effect of this amendment essentially removes the eligibility requirement that “natural death has become reasonably foreseeable”. This amendment appears to have been motivated by a concern that this criterion is unconstitutional because it does not explicitly appear in the Supreme Court Carter decision.
Many legal experts have testified before the Standing Committee on Legal and Constitutional Affairs in the other place. Some expressed their views that Bill C-14, as initially passed in the House of Commons, would be found unconstitutional if challenged in the courts.
However, other legal experts and professors took the opposite view, that Bill C-14, as adopted in the House of Commons, with the requirement that natural death be reasonably foreseeable, is constitutional. In Carter, the Supreme Court was clear that it is the role of Parliament to craft a complex, regulatory regime with respect to medical assistance in dying and that such a regime would be given a high degree of deference by the courts.
Hon. colleagues, as Minister of Justice and the Attorney General of Canada, I am confident that Bill C-14, as originally drafted and presented in this place, is constitutional. As outlined in an addendum to the legislative background paper that I distributed to all parliamentarians earlier this week, and which I am pleased to table in the House today, the question is whether the complex, regulatory regime found in Bill C-14 is consistent with the charter, not whether it exactly replicates the wording of the Supreme Court in Carter. In the dialogue that this Parliament has with the judiciary, Bill C-14 is our principled, cautious, and deliberate response.
This is a transformational discussion, and a significant first step for our country. It is important to note that Bill C-14 is very different from the former law that was before the court in Carter. Our proposed legislation permits medical assistance in dying for the overwhelming majority of those Canadians who would seek to access it, and it is motivated by broader, new legislative objectives that do not animate the former law.
Bill C-14 is a new law with new features, and an analysis of its constitutionality must reflect this. The Carter ruling alone is not the end of the story, nor is it the end of our national discussion. The conclusion to draw here is that there are diametrically opposed but reasonable points of view about the constitutionality of Bill C-14.
The situation is not unique. It is normal and part of a healthy debate for legal experts to differ on the merits of a particular piece of legislation that has not yet been examined by the courts. However, I would caution that fundamentally altering the delicate balance purposefully struck in Bill C-14 solely because of the existence of these differing views is ill-advised.
As the Supreme Court of Canada stated in Carter, “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards”. The government's policy choices, as reflected in Bill C-14, were specifically crafted to protect vulnerable Canadians from these different types of risks.
First is the protection of those who will ask for medical assistance in dying. Bill C-14, as passed by this chamber, would limit eligibility to those whose death has become reasonably foreseeable and for whom the risks can be adequately addressed by the robust safeguards found in Bill C-14. However, if eligibility is drastically expanded to all Canadians who are suffering unbearably, regardless of whether or not their death is reasonably foreseeable, as in the amendments the other place proposes, there are more risks of different types that are much harder to detect.
These risks include the very real possibility that individuals may be motivated to request medical assistance in dying for a whole host of reasons, psychosocial, emotional, or systemic, which are separate from their medical condition but that exacerbate their suffering. People may die unnecessarily or prematurely, when other options for improving their quality of life are available. Cases from other jurisdictions that permit medical assistance in dying support these concerns. We do not believe that this is what Canadians want.
Importantly, while the other place expanded eligibility in the bill, it did not introduce new safeguards for the very circumstances where the most caution is required. The result is that any serious medical condition, whether it be a soldier with post-traumatic stress disorder, a young person who suffered a spinal cord injury in an accident, or a survivor whose mind is haunted by memories of sexual abuse, could result in eligibility for medical assistance in dying. I raise these examples from other jurisdictions not to be sensational, but to highlight the real risks at play.
However, beyond the risks for those who make a request for medical assistance in dying, making it available to all Canadians who are suffering would also have repercussions at a much broader level. It would alter our societal values and send the wrong message to our most vulnerable Canadians who may never even request assistance. These are risks for which there are no obvious safeguards.
Broadening eligibility for medical assistance in dying to situations where death is not reasonably foreseeable would contribute to negative perceptions about the quality and dignity of life of people with disabilities. Organizations like the Canadian Association for Community Living and the Council of Canadians with Disabilities, among other disability rights organizations, have cautioned us about the potential devaluation of the lives of Canadians with disabilities that broader eligibility criteria would attract. They tell us that such devaluation happens when the law presumes that life with a disability could be so unbearable that death should be a state-sanctioned option.
Broad eligibility criteria could also send the wrong message that society feels it is appropriate to address suffering in life by choosing death. This message may encourage some who are in crisis and already considering suicide to act, even privately and without assistance. Procedural safeguards would not help these individuals. The relationship between medical assistance in dying and suicide has not been sufficiently studied and we must have more information about this complex situation before we can decide what is right for Canada. I want to acknowledge the thorough and emotional discussion in the other place on this incredibly important issue.
We recognize the important amendments to Bill C-14 adopted by the other place, namely that a person signing on behalf of the patient requesting assistance cannot know or believe that they will benefit from the patient's death. This is indeed a thoughtful amendment that improves the bill and a valuable safeguard that we are pleased to support. Ensuring that a patient is aware of all means available to relieve their suffering, including palliative care, is of course important.
A further amendment concerning the monitoring system introduces mandatory language requiring the Minister of Health to make regulations and guidelines. The government appreciates the other place's concern that regulations to support the monitoring regime be put in place. Canadians want to know that this system will be well monitored and we support this well-crafted amendment from the other place.
Further, there was an amendment requiring that the issues to be studied in the bill, which are mature minors, advance directives, and requests where the sole underlying condition is mental illness, be completed in two years. This amendment from the other place reflects the concern that Canadians have for these incredibly complex issues, and the desire for this government to be held to account on each of them, and for that reason it is supported.
I would also like to acknowledge the substantive work of the Standing Committee on Justice and Human Rights, whose thoughtful study of the bill resulted in 16 amendments from all parties being adopted.
I would urge all members of the House to consider the pressing need for a federal legislative framework governing medical assistance in dying. With no such regime in place at this time, with the force and clarity of the criminal law, all Canadians face significant uncertainty.
It is crucial to keep in mind that Bill C-14 was carefully and deliberately crafted as a cohesive and balanced regime. The balance sought in Bill C-14 would be upset by the broadening of eligibility criteria to individuals who are not approaching death without the corresponding safeguards for these specific cases.
Since forming government, we have spent countless hours consulting with Canadians and stakeholders, carefully considering all of the evidence and diverse perspectives on this incredibly challenging issue. We are confident in the policy choices expressed in Bill C-14. The legislation represents the right approach for Canada at this important time in our country's history. I encourage all members of the House to support the government's motion, which respects the other place's contribution to this important debate and maintains the most appropriate balance for all Canadians.
I am pleased to table, in both official languages, a document entitled, “Legislative Background: Medical Assistance in Dying (Bill C-14)—Addendum”.
