Mr. Speaker, I am pleased to have the opportunity to participate in today's debate on the way forward in responding to the recent decision from the Supreme Court of Canada on the issue of physician-assisted dying.
On February 6, the Supreme Court of Canada concluded that the Criminal Code provisions on physician-assisted dying are contrary to the charter. The court suspended the legal effect of its ruling for 12 months to give Parliament time to develop an appropriate response.
The government opposes our motion because we have committed to hearing from all perspectives on this issue. This consultation process would provide an opportunity for Canadians and stakeholders, such as physicians and nurses, disabled people, and patients' rights groups, to share their views and perspectives.
We cannot underestimate the importance of engaging all Canadians in this dialogue. It is hoped that everyone will work together so that we can create a regime that would meet the needs of those who are grievously ill and who want to die in order to escape intolerable pain, while at the same time protecting vulnerable individuals and affirming our shared value that all human beings, no matter their condition, have inherent dignity and worth.
We are, thankfully, not starting at zero. There is much that we already know about the risks that are inherent in the practice of physician-assisted dying, the types of safeguards that can help mitigate those risks, and how these practices can be monitored. Much of what we know was presented at the courts as evidence in the Carter litigation. I believe it could be helpful if we consider some of the filings of the trial judge. The trial judgment itself is full of relevant information about how these laws work where they exist.
This is definitely an issue upon which people can have differing views about what is appropriate or acceptable for a societal response, but we should all be striving to form a common understanding of the facts.
One important question that was raised many years ago was whether legalization of physician-assisted dying would have the unintended effect of impeding progress in improving the quality and availability of palliative care services.
With regard to palliative care, I would remind all members that in May 2014, this chamber overwhelmingly passed Motion No. 456, calling upon the federal government to establish a pan-Canadian palliative and end-of-life care strategy.
After examining the evidence from the jurisdictions that permit some form of physician-assisted dying, the trial judge in Carter found that palliative care services were not undermined in these places; in fact, in some places, more physicians now seem to have a better understanding of palliative care than they did before the legalization of physician-assisted dying.
While the court did not find that these improvements were the result of legalizing physician-assisted dying, it is nonetheless good news that palliative care can be improved alongside an assisted-dying regime. I think this will be important to bear in mind going forward.
Another concern that is sometimes expressed is that legalizing physician-assisted dying can have a negative impact upon the doctor-patient relationship, as some may come to fear their doctors once they are empowered to help end life.
Moving forward, we as a society must be mindful of this relationship. For example the trial judge found that, if a future law were carefully designed with appropriate safeguards, patients' trust in their physicians and physicians' commitment to their patients' well-being would not necessarily change for the worse. Furthermore, the risk of misconception and distrust may be counterbalanced by the possibility of enhanced trust arising from more open communications.
However, there does appear to be evidence that, in Canada, not all physicians are having honest conversations with patients about their prognosis and options at end of life to the degree we would hope.
Perhaps the prospect of legalizing physician-assisted dying presents us with an opportunity to help physicians improve their skill set in this area, for the good of all patients, not just those who would seek to have assistance to die.
The evidence from the Carter case also revealed interesting facts about the reasons people provide for seeking medically assisted death. I think most Canadians believe that those who seek assistance to die are suffering from intolerable physical pain. The media often describe cases involving horrific diseases that lead to painful and debilitating deaths.
The data that is collected from places where people can access assistance to die tells us a very different story. In fact, inadequate pain control is almost never a reason people seek assistance to die. On the contrary, almost all people who have received assistance wanted it because they were suffering from loss of physical autonomy, reduced ability to engage in activities that made their life enjoyable, feelings of loss of dignity, losing control of bodily functions, and feeling like a burden on family.
People are seeking to die, not because they are in physical pain, but because they are in emotional and psychological pain. It is important to know this if we strive to provide real options to Canadians at the end of life.
The data tells that, in every place where these practices are legal, the clear trend is increasing for numbers of people accessing assistance to die with each passing year. Even in places like Oregon, where the law has been in operation since 1997, the number of people seeking assistance to die continues to grow with each passing year.
The data reveals another interesting fact about the Oregon model. In Oregon only physician-assisted suicide is legal, and only for people who are terminally ill. The law permits a physician to write a prescription for a lethal dose of medication to a person with an illness that is reasonably expected to cause death within six months.
The data tell us that, every year, about one-third of the people who receive this prescription do not use it. Are people obtaining a lethal prescription when their wish to die is temporary or they are not entirely firm in their desire? On the other hand, some say that simply having the prescription and knowing it is available for use if one's situation becomes unbearable is in itself a way to ease their psychological suffering so that they can continue to live.
The data also shows that some people who receive the lethal prescriptions die more than two years later, even though according to the law, the prescription is only available to a person who is reasonably expected to die within six months. This fact suggests there are real challenges associated with physicians' ability to predict how close a person is to death.
Our challenge would be much more difficult without all this information. This information is available to us because every jurisdiction that legally regulates physician-assisted dying has a legal requirement for physicians who provide assistance to report that they have done so on some authority. In some cases, the relevant authority is the health department of the state; in other cases, it is a specially created commission. In all cases, the relevant authorities are required to compile and analyze data and to issue public reports on key facts, such as the kinds of medical conditions of the people who are aided to die.
This data is invaluable to Canada and no doubt to other countries that are grappling with these issues. Their reporting requirements also serve as an accountability measure, which is just as important. These are just some of the important facts we must all come to appreciate as we move forward with this conversation.
