Elizabeth May

“Mr. Speaker, I will be sharing my time with my colleague from Argenteuil—Papineau—Des Collines. I rise today to give voice to the people of La Prairie—Atateken, many of whom have spoken to me about this bill. I also do so as a physician who was closely involved with medical assistance in dying in my medical practice. This bill touches on one of the most intimate questions a society can ask itself: How do we wish to accompany people at the end of their lives, and above all, how do we respect their wishes when they are no longer able to express them? Through Bill C-41, the government is proposing to allow advance requests for MAID. A person diagnosed with a serious and incurable illness leading to incapacity, such as Alzheimer’s disease, could give their consent in advance, while they are still of sound mind, to receive this care at a later date. Let me start by saying that I welcome this step forward. For many Quebeckers, this has been a long-awaited development. Quebec did not wait, as the National Assembly of Quebec adopted an advance request system, and those affected can now submit such an application to the Régie de l’assurance maladie du Québec. They do so with the help of their doctor or specialized nurse practitioner, and they themselves describe the symptoms of their illness that they would consider intolerable. This system exists, but it is currently on shaky ground. The Criminal Code does not yet permit advance requests. The Attorney General of Quebec has asked the director of criminal and penal prosecutions to issue a directive: It is not in the interests of justice to bring charges in these circumstances. Our doctors and nurses act in good faith, but without the legal certainty that only the Criminal Code can provide. Bill C-41 corrects this situation. That is its first and greatest merit. That said, supporting a bill does not mean giving up on improving it, quite the contrary. This is a serious matter and we have a duty to get it right. I would therefore like to share a few thoughts with my colleagues for our work in committee. First, I want to talk about consistency across the provinces. The bill establishes minimum federal requirements and then leaves it to each province to decide whether to enact legislation allowing advance requests. Health care falls within provincial jurisdiction, and Quebec is, quite rightly, keen to retain its own model. However, we must be clear-eyed about the risks involved. Alberta has already passed legislation prohibiting advance requests. The Minister of Justice himself has acknowledged that greater consistency across the country may eventually emerge, but that process could take months, or even years. Dignity With Dying Canada goes further. According to the organization, this approach effectively gives each province a veto over access to advance requests. If every province develops its own forms, rules and procedures, we risk creating a veritable Tower of Babel. What will happen if someone has signed a request in Candiac and then moves to Ottawa to be closer to family? That could very well be my situation. I therefore propose that the committee examine the possibility of establishing a common framework, namely a set of core elements that any province choosing to allow advance requests should include. This is not about imposing a single model, but about ensuring that individuals have a basic level of protection and clarity, regardless of where they live. There is also the role of trusted third parties. I talked about it a little earlier. In Quebec, an individual may designate one or two trusted third persons. These loved ones have a specific responsibility: to notify the care team when they believe that the signs set out in the advance request have in fact appeared or that the person is suffering intolerably. This is an essential part of the process. An advance request can sit in a registry for years. Without someone to bring it to the care team’s attention, it could easily be overlooked, yet the national requirements set out in Bill C‑41 make no mention of this role. In my view, it should form part of the common framework, and its responsibilities should be clearly defined. Indeed, it must be said that those responsibilities are not even clearly defined in Quebec’s legislation. Every trusted third person should know exactly what their responsibilities will be when the time comes to provide medical assistance in dying. We should also think about people who have no one, such as isolated seniors with no close family. The Quebec system states that, in the absence of a trusted third person, the health care team takes over. I respectfully submit that this is an avenue worth pursuing. Third, there is the 30-day rule. The bill rightly provides that a clear refusal, expressed through words, sounds or gestures, renders the request invalid, but it also provides that, in cases of doubt, the assistance cannot be administered and a minimum period of 30 days must then elapse. The Quebec legislation is just as firm on the principle: “Any refusal...must be respected and it is prohibited to disregard it in any manner.” It also recognizes a clinical reality. In a person with advanced dementia, resistance to care is often a symptom of the disease itself. That is why it leaves it to the professional’s judgment to determine whether it is a genuine refusal. I am concerned that an automatic, repeated, endless delay could prolong the suffering that the person initially wanted to avoid through their advance request. It could also expose health care professionals to pressure from loved ones who oppose MAID. I hope the committee will examine this provision carefully and consider how it aligns with the Quebec legislation. Fourth, and this is my main point, suffering is a condition for accessing end-of-life care. For a standard request, the Criminal Code recognizes physical or psychological suffering that is intolerable to the person and that cannot be alleviated under conditions the person deems acceptable. For an advance request, Bill C-41 instead requires practitioners to determine that the suffering “cannot be relieved through reasonable means”. Consider the person writing their request. What they often fear most is not so much physical pain as the loss of self: no longer recognizing those they love, being entirely dependent on others. The committee will have to consider how much weight to give to what the person themselves defined as intolerable when they were, in fact, in full possession of their faculties. I dare say that this should carry as much weight as a third-party assessment, one fraught with pitfalls, in the case of a person with dementia. After all, if we wait long enough, it is possible that the person with dementia will no longer even be able to express their sadness, let alone their suffering. Lastly, and incidentally, there is one question we too often overlook: organ donation. In Quebec, a growing number of people who receive medical assistance in dying also choose to donate their organs. In 2022, close to 15% of Quebec organ donors had used medical assistance in dying. It is an act of tremendous generosity that gives meaning to a difficult moment, but the process relies on consent being provided by the individual themselves after a period of reflection. What happens in the case of someone who makes an advance request? Once they become incapacitated, they can no longer take these steps. That is why it is important to address the issue at the very time the advance request is being prepared and to confirm whether the individual would like to donate their organs when the time comes to receive medical assistance in dying. Behind each of the bill’s clauses are families and people. People in La Prairie, Saint-Constant and Kahnawake have all seen a relative slowly die, and have promised themselves to never put their loved ones through the same experience. Their request to us is simple: that their wishes be respected. Bill C‑41 moves us closer to this goal. We must work together in committee to ensure that it fully achieves it.”